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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 /> & �� A e..,-, _ El Zoning Status; CUP; <br /> OWNS ADDRESS (Number,Street,City,State,zip) Deed Restriction; CSM <br /> �l a c,vt Iti 5 5 c <br /> ~Tt PPe a,. Variance(# ) <br /> HOME PHONE CELLJHONE EVAIL ADDRESS <br /> 0 0k-2-19 SZIO r +-s ,..9.,-- ° vv,e ■ ,C°-^- ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> j \4.>1-i--Av4�ti A l - i`^ ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR A RESS of well/septic <br /> (.%1'2-o f4• G��M■d1 e-- D-r <br /> (City,State,Zip) (City,State, ) El Setbacks <br /> PHONE PHONE / ❑Site Plan approval from <br /> ef/CQ) - '4'0- -69b4C1 applicable township. <br /> E-MAIL ADDRESS E-MAIL A E J4 <br /> jv " NQ e, fil, d D •C..P' -, ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane-wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑UM ER DC U�2. o� eOOD� frontage drawn to scale. . <br /> TOWNSHIP: SECTION: <br /> • + , , ❑ Driveway permits <br /> `eta t.✓■ G t�l eC�vvt /4: /4 A: <br /> (state,county,town)5 114-' / ( y� ) <br /> 6 g 1 ( t p��d r 1 CA Ot e GSUBDIVI ON s c i BLOCK/LOT <br /> ❑Sanitary LOT ry permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / <br /> Add I-frt CA. 1 f>C,\- D Zoning District <br /> ❑This project is a new building or structure. <br /> El Permitted Use? <br /> is project is an addition/alteration to an existing building or structure. I--1 <br /> SANITARY SERVICE: PERMIT NUMBER: Li Rural Address '. <br /> FIEWER [EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> I i c)-r 0 Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOO i <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FL o Li ErosionControl permit <br /> t S 4, TOTAL SQUARE FOOTAGE: (Slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 'Cl ,� t ❑.Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: --:and available options. <br /> (Please round to nearest dollar) l( <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ENo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes [ lo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑No ,1,/0'( .16-7- <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Elves [ilc10 <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 �Klo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 0� <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) ■ -i <br />