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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO P OVIDE <br /> rr �� Zoning Status; C / f� <br /> OWN ADDRESS ((N Number,Street,City,State,Zip) M 3.,Ci ; S 010 Peed Restriction; CSM/lit, A- <br /> 1 d 4 l .3,\C Yl,S %r `I J 2, ' 110 -7---- (,L} L, S37/9 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> L i ' 2o6 - , �� 'Site Plan drawn to scale 0 <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimension <br /> AGENT NAME CO RAC OR NAME <br /> R,is ' / /' 4 Site P .• •• •ing location! <br /> AGENT ADDRESS CONTRACTOR ADDRESS •- ell/septic 1 <br /> 2 3 l - Iri'i ,r, 59' 30 2 5/. ?S, <br /> (City,State,Zip) (City,State, ip) ^ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> O_3'SJ applicable township. <br /> E-MAIL DDRESS <br /> E-M �--05�/-eo S✓�p D 4 Floor plans to scale <br /> )7 /f <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> P ENT PARC L NUMBER: CURRENT ONING: ACREAGE: ;t/ Elevation of property <br /> ARCEL p6--10-54-1-00 3 , 11 - '4,4 -3 frontage drawn to scale. <br /> NUMBER <br /> TOWNn$HIP: SECTION: /may/ f�/7�-/��/ <br /> 5 Y 5 5,/74. -S E 1A1 A: � J�Driveway permit <br /> A D (state, county, wn <br /> � p" j rzfe Sanitary per. its <br /> CS LOT <br /> SUBDIVISION/4 LOCK/LOT <br /> C 6-5-444A/ '� (public, frla <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW r <br /> PROJECT DESCRIPTION: pii— <br /> e0 t/ r O r ,Zoning District _ a- <br /> /c <br /> is project is a new building or structure. rl Permitted Use? s r / <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PER7 BER: <br /> 249/5-- <br /> ' /�� © )3 Address •7 3 ( ' <br /> (SEWER PTIC existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> etla loodplain/ `` <br /> o reland ent) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEM T: 1ST FLOOR: ErosionControl permit <br /> O 3 89 8 j TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, / <br /> •111/// filling/access) ' /; <br /> 2ND FL ® 3RD FLOOR: ó D ,Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: <br /> —0. ♦ ♦ ♦ ♦ —I. QQ�� �� n and available options. <br /> (Please round to nearest dollar) $ 7 T / �� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No [ eOn't know <br /> 2. Is there a wetland or floodplain on or near the property? Es ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? girds ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes [Y]No <br /> 5. Is this project associated with a rezone/CUP/variance_ •- • • - ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ----.IIIIU Yes ❑No Et6on't know <br /> 7. Is this to correct a violation? r es Pcto <br /> 2 V, 50 APP ICATION MUST BE SIGNED <br /> .ntinue on Back) ■ ■ -0 <br /> 545-112(4/08) <br />