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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 /> �}-�OrvmA L £ . L1 ) & ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City, <br /> State,Zip) <br /> Deed Resiction; CSM. ,I 3(o Sd A 1h fLLGK ?i Lo b I ,J I S3 S S 5 Varia nce(# <br /> ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608 —Sig,-578S 6r6-aQ-8I 31 e,r1 dr€. '.t m @4ds'.n eT ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER:0 9o8-083-, CURRENT ZONING: ACREAGE: <br /> ❑ <br /> PARCEL WI 00_ ) A_i V frontage drawn to scale. . <br /> NUMBER <br /> �• <br /> TOWNSHIP: SECTION: <br /> �A F '/4: 14%: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> q S(7 L..t. kb Loo) <br /> ❑ <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> .l / �� / (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> MD I T,a,,, To EX i 51/n)G Mil c1-1//1)6 S� U0 Q Zoning District <br /> - ❑This project is a new building or structure. Li Permitted Use?. <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER [)EPTIC A t Sc-1)7"i (new/existing) <br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE F OT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: S f- <br /> 1 ❑ ErosionControl permit <br /> 0%0 4, TOTAL SQUARE FOOTAGE: (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: S't <br /> filling/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST -► and available options. <br /> (Please round to nearest dollar) ) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes ❑No EDon'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'? ®Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes No <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 /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► <br /> 545-112(4/08) <br />