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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> ME= <br /> PROPERTY OWNER INFORMATION iir STOMER TO PROVIDE <br /> OWNER NAME L <br /> PA' v---5/.--pr 5 ..- e e"r FA Z ping Status; CUP; <br /> OWNER ADDRESS (Number,Street City,State,Zip) _ <br /> 3��n eed Restriction; CSM <br /> 6/c t' �� • 2 i'?2-'ZG'r7�r,-7i�� Gt'/� S ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> °Z -i '0Sic--- Sit Pan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION an ' eludes dimensions <br /> AGENT NAME > CONTRACTOR NAME <br /> ca// S�-ll'e,24-- Si Plan including location <br /> AGENT ADDRESS / CONTRACTOR ADDRESS o well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> wy 3c jl <br /> PHONE PHONE n It Plana al from <br /> �i t <br /> �5 j a I e township. CA i A E-MAIL ADDRESS E-MAIL ADDRESS � <br /> d 'Lor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> PARENT PA E N MBER: CURRENTZO G: ACREAGE: p p y <br /> ❑ PARCEL 0 C _ ( I I ,A=No �j .. ' //a frontage drawn to : ale. <br /> NUMBER l' �' l� U / <br /> TOWNSHIP: SECTION w� <br /> C\2—�, ( 1 1/: N E ,/4,/4: I� E ❑ Drivewa :-rmits <br /> ADDRESS: (state ounty,town) <br /> Co / 0 _S .F� /,\,,l �' I- <br /> CSM: LOT SUBDIVISION BLOCK/LOT I I S: itary permits <br /> (aublic, private) <br /> PROPOSED PROJECT INFORMATION ipr STAFF REVIEW <br /> PROJECT <br /> I DE5CRIPTION:�x,,11// C ti' . <br /> LS�..--� •J\ � ® 6 te. ■ Zoning District <br /> . ❑This project is a new building or stru turee ' (�ru°i'5f/-./c7�in.ti ❑ Permitted Use?1, <br /> n This project is an addition/ Iteration to an existing building or stuctu . <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rur Address <br /> (SEWER EPTIC (new xisting <br /> HEIGHT IN FEF: ( NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/F dplain/ <br /> Aft • Shorel d (attachment) <br /> AREA TO NEAREST SQUARE FOOT: I <br /> (Outside dimensions including unfinished area, attached g ages and above grade decks or porches) <br /> aggEn^ENT: 1ST FLOO. I I ❑ ErosionControl permit 4 <br /> r ( 0 �r 1 TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: �p \/ filling/access) <br /> ❑ Review Location Survey \ lit <br /> ESTIMATED CONSTRUCTION COST: O�O � l v�V and available options. -' ' <br /> Please round to nearest dollar) --► ♦ ♦ ♦ $ 110 Uc <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? n Ye 11116 ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑ es lo ❑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 laKlo <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) nYes ErNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes [ o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ ♦ —► <br /> 545-112(4/08) <br />