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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Thomas 1, �UCh Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 31s1 Can a I Zcl Marsha L,)l 53SS9 Variance(# <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> fool.-6455-3 t 7' C•all b a. s lie• maa t • corn Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> G reen I i Oe_ COn&-, hL Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2. S L Main S± <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> P1arrhall j!)j 535 <br /> PHONE PHONE Site Plan approval from <br /> (DOB ata 84, applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> btaka. 47 i n• cslns . i ,( — Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P p y <br /> PARCEL <br /> N UMBER O8 I I I,.iSO i O(p frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Meal'rt a 1/4: _ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 31°1 Ca.la Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Deck ❑ Zoning District <br /> . X=This project is a new building or structure. ❑ Permitted Use? <br /> 'This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> - -SEWER rC -SEPTIC (new/existing) <br /> HEIGHT IN FEET: /� NUMBER OF STORIES: (Not induding basement) <br /> ❑ Wetland/F000dplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> TOTAL SQUARE FOOTAGE: (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 9 2 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: Q. Q ��g O $ and available options. <br /> (Please round to nearest dollar) — - _ 5c5c:19. Op <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? X Yes No Don't know <br /> 2. Is there a wetland or floodplain on or near the property? - -Yes No - -Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? XYes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes .XNo <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Yes -K No Don't know <br /> 7. Is this to correct a violation? - -Yes X-No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />