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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 /> 4-A RA? f 1ql 44, b ❑ Zoning Status; CUP; <br /> OWNERADDRf SS (Number,Stre t,City,State,Zip) Deed Restriction; CSM <br /> ci Ar g 19 6 —/'_ e 1/ Al L s3 J---31- Variance(# ) <br /> HOM PHONE CE L PHONE / E-MAIL AF/DRESS <br /> ...r. , , - •S 60 F ae 7 59 1 a ,A , - IL" ,,; ■ • A ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CON'.RACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ N MBER O5'la- %3I- 7 7k05' /Q1 cs)2,s— frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> (-}18(o 1/4: 1/41/4. ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION F REVIratit' <br /> PROJECT DESCRIPTION: ' <br /> e*-�'G4�/ 4-c,e.sso ry Z3 / — Z1 n sf�' <br /> . ❑This project is a new building 6r structur . ''' <br /> 4��> Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 0 Rural AAddress <br /> i Aso, <br /> fSEWER SEPTIC {new/exlstin <br /> HEIGHT IN FEET: �i-P-4-.r J NUMBER OF STORIES: (Not including basement) *if;, <br /> shoreland (a�Iment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outsi.e dimensions including unfinished area, attached garages and above grade decks or porches) "�h <br /> BASEMENT: 1ST FLOOR: <br /> �� Gl:��tlQlIt <br /> 4, TOTAL SQUARE FOOTAGE: 4, (7�,diSurbl cee <br /> 2ND FLOOR: 3RD FLOOR: I/ <br /> YCJ7GP S - ,! Revue . <br /> ESTIMATED CONSTRUCTION COST: $ <br /> (Please round to nearest dollar) '♦ ♦ ♦ ♦ ♦ ♦ $ 7 d o d d Q and,. o <br /> ;,c-t,-,_ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes r 'No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? es U No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [ Yes 2No <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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? �EYes NNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />