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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App S <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 50lee,'1 + Ma r-kj Bt eu,1 1‘9 ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zi?) Deed Restriction; CSM <br /> G(cco 0...cuA4LA(...cu.-4 kccCl Y MGZon nit.(kJ: 535&O Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ,-g -013y"6$' 6031.135 47/O Jl ►Dce.u,-.∎5eC•mcit( , CcI'V\ <br /> 1=1 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> (_-c,t1 Set- CO:15j- u L-1 G:-1 ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ICCC Pa-,;r;e. S\I ee+ <br /> (City,State,Zip) (City State,Zip) . Setbacks <br /> r.; r; c_ a .x,c (�;�. 52540 <br /> PHONE PHONE -- El Site Plan approval from <br /> j,i3 -(c.L1 3 S1/9 applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> XFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accsssdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑PARCEL hh� /� //�� ��// ' frontage drawn to scale. <br /> NUMBER tiJ�-OcO -" LI -gcCC-� , L. CE X) �.� g <br /> TOWNSHIP: SECTION: <br /> M CA Z 0 mc.,v1%�— Y.: Y4%: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 9(P00 et.:.C/1 Ili HiyhwC.4 Y MpLc., Airy W 5.3 S(:0 <br /> CSM: LOT SUBDIVISION BLOCK/LOT El Sanitary permits <br /> NR Na (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 594 S`1'`'`^ce -6,- oc`clt-FlOn ❑ Zoning District <br /> . ['This project is a new building or structure. <br /> ❑ Permitted Use? <br /> [This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER REPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 7 / 1 ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ ErosionControl permit <br /> BASEMENT: / op i, 15T FLOOR: a ,...1 30 i TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> /Z 5L !� 3� filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 7..,2 -lib"' <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ `/ 6) �D 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ,®No ❑Don't know <br /> ?[J <br /> 2. Is there a wetland or floodplain on or near the property? Yes 'o ❑Don't know <br /> ® <br /> 3. Have you talked with the township about your project and are they in agreement? Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 'lo <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 , No ['Don't know <br /> Cov 7. Is this to correct a violation? DYes jalo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />