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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C -TOMER TO PROVIDE <br /> OWNER NAME <br /> 192 1tcL XI 11 d 1/ C s ��� <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ►I Z Ing Status; CUP; <br /> it/ I S I3 r t hy• 4 V� �a�I c o 0 ) eed Restriction; CSM <br /> ariance(# ) <br /> HOME PHONE CELL PHONE - ,E-MAIL ADDRESS <br /> CP8 5 76'ii> /44iT in had <br /> ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> lot h. C Si e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS o well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE ❑S' a Pla proval from <br /> le township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> F oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us� levation of property <br /> PARENT PARCEL NUMBER: (� EN ZONING: ACREAGE: P P y <br /> ❑NUMBER 07 I I d qc s J -Q� I i �� frontage drawn to sc <br /> TOWNSHIP: SECT E11: VVV <br /> C D'ftom- 9 u 0 r D V u ,/4: /v , , ❑Driveway its <br /> /a/4: (state unty,town) <br /> ADDRESS: <br /> 4- -) C 9- 6 auto » v, <br /> CSM: LOT S DIVISIO1 BL'OCK/LOT ❑Sanita.private)s <br /> }�,� VN a. + (pu• c,private <br /> PROPOSED PROJECT INFORMATION % STAFF REVIEW <br /> PROJECT DESCRIPTION: 4 _ 11 11' <br /> 1 I �. a -oning District,,; <br /> . ['This project is a new building or structure. a.Permitted U -? <br /> [r]This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: f\ , ❑ Rural ' ■dre ' <br /> F1EWER rEPTIC (new/-,*stint. <br /> HEIGHT IN FEET: [^ NUMBER OF STORIES: (Not including asement) <br /> 11'x, NUMBER ❑ Wetland/F dplain/ <br /> Shore] d (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached g ages and above grade decks or porches) <br /> BASEMENT: { I� ❑ ErOSIOnCOnt it <br /> I � 1ST FLOOR �J( 4, TOTAL SQUARE FOOTAGE: 4, (S lopes,y thence,, <br /> \ VVV 7 fillip ss) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Review Location Surve <br /> ESTIMATED CONSTRUCTION COST: -► $ 3 (�� and available options. <br /> (Please round to nearest dollar 3 O ill../// <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 /> 2. Is there a wetland or floodplain on or near the property? s ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es ro 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Y s <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (le ve blank i one) <br /> 6. Is a location survey required? (see reverse) es o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> _44".* / <br /> g APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -r -► <br /> 545-112(4/08) <br />