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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 /> s1. /tt O 1-441444 Li 16teG1(an_ ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 2404, Catgi rey t/ PHONE 4. 1: E-MAIL ADDRESS Variance(# ) <br /> HOME <br /> 24 5- ' 50 S !o-1 1 e6 7 DAiit oc • , '' CAA-a-T a. .1Je''y1 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> /V31 nn PAV I,e.! •) .O,-VteS.i SOUS RE too et 106, ESite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1801 $'GONj( go. 4a01 ma— RP . <br /> (City,State,Zip) (City,State,Zip) ' [ZI Setbacks <br /> f'l0aOA , (4 53-((( r1 r�+q, kn 5371& <br /> PHONE r PHONE ❑Site Plan approval from <br /> -2-y-2—(v G 01 2'Z1-- & Q 9 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> V) 41 we • 4, .c 0 ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> PAR frontage drawn to scale. <br /> NUMBER CEL �i(1 _,3Z._&4 Q-C) A ( Z. o7� <br /> TOWNSHIP: SECTION: <br /> fiteAlEAVOT 3p N4.5 '/4: WA: ❑ Driveway permits <br /> DDRESS: (state, county,town) <br /> 24+3 Cowv??, PO • 13 ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 'V 4-4-at) 4W-/q-Cr- ❑ Zoning District <br /> project is a new building or structure. <br /> ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER .1 EPTIC (new/existing) <br /> HEIGHT IN FEET: 1 v NUMBER OF STORIES: (Not including basement) <br /> S I ❑ Wetland/Floodplain/ <br /> Shoreland (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: <br /> ❑ ErosionControl permit <br /> - 1 Q co s 1 TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 1 filling/access) <br /> 2ND FLOOR: .3RD FLOOR: I h 50 <br /> lJ ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ -► ♦ -► -7 , and available options. <br /> (Please round to nearest dollar) $ l l 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes ❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? E Yes f 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# ) (leav blank if none) <br /> 6. Is a location survey required? (see reverse) Is ENO ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes QNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ -► <br /> 545-112(4/08) <br />