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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME/J 1 1 <br /> rL-1 .mow ?o \ li °c '� • ' ❑Zoning Status; CUP; <br /> PAN% <br /> RADDRESS (Nu ber,St et,City,State, ) ' �^ D�_ed Restriction; CSM <br /> IAA, su C � UV\ ,��w t �31I3J riance(# ) <br /> HOME PHONE�1 CELL P E-MAIL•D!' SS / / <br /> ,0.'u° I ll' (faO27 51G- 0b h' ° - CO t- - ,. Q-,c-ow.Q USi#e Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION end includes dimensions <br /> NAME I CONTRACTOR NNE <br /> rzzi27 - .• 1 G-�os r 5� <br /> C cu to„„ ____ KSOtA Site Plan including location <br /> AGENTADDRES I' CONTRACTOR DDRESS of well/septic <br /> Cl)q Sct\t 1 121`1 1 Pas�v.� <br /> (Ci y,Stat Zip) `� (C.y State,Zip) E Setbacks <br /> ��`` may., t . G,1C2 ■`o �'(. 53I-Z'13* <br /> PHONE t PHONE 5 r Site Plan royal from <br /> ❑ approval <br /> - Oi-Q I 1 t 742 -Tj Lj 2,- 94\-4-0 applicable township. <br /> E-MAILADI RES /_ E-MAIL ADDRESS /� /� <br /> ■ ,iv Dove(- • i�O _• L0'"`' �o _I o�hSovt C"i l��w.a5 •GO►^^ ® Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMB R: ,1 CURRENTZONING: ACREAGE: LI' Elevation of property <br /> ❑ PARCEL 0711 -�S c UCH C .. l ,�, ll frontage drawn to scale. <br /> TOWNSHIPS ` C 711 ' -3(=� - 1/0 �SECTIO <br /> CC 'k_O NS` �� -A& 1/4: �, 1/41/4: ❑ Driveway permits <br /> ‘k TRESS v (state, county,town) <br /> \ a. ` �d n <br /> • <br /> CSM: LOT SU IVISION BLOCK/LOT Sanitary permits <br /> C .� 1 a (public, private) <br /> PROPOSED PROJECT INFORMATION i /STAFF REVIEW <br /> P OJECT D $CRIPTION: <br /> Ne� ki'lc,k� Ol� �`- roC e t,�tcr,� �j(c.c,0 w,�iv.,1,e, koning District <br /> his project is anew building or structure. �J <br /> ❑ Permitted Use? <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT U ER: ❑ Rural Address <br /> nSEWER �(SEPTIC 7 0�, o O/ )() (new/ xisting) <br /> HEIGHT IN FEET /1!~•y NUMBER OF TORIES: including basement) <br /> 2l/ b(1 / 0v∎c.�n,u5 VW0-z?.6-Yttn� I Wetland(F,,loodplain/ <br /> l Shorelarid (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ❑ ErosionControl permit <br /> ZQ WO A/ 114000 1 j TOTAL SQUARE FOOTAGE: 4, slopes,disturbance, <br /> f��/ ii/ �Ul I filling/access) <br /> 2ND FLOOR: 3RDELOOR: 1 2), <br /> 1 I Review Location Survey 1 <br /> ESTIMATED CONSTRUCTION COST: $ '), )6.010/j. aC� and available options. '' L <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 M • ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 4 Yes or o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? M Yes ❑Nod` L e, . C:C i(`_s <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? El Yes ❑No e Ay. <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) 1 <br /> 6. Is a location survey required? (see reverse) ❑Yes 1 No ['Don't know <br /> 7. Is this to correct a violation? ❑Yes El No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -* ♦ -+ <br /> 545-112(4/08) <br />