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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> •.'k : ►'ME <br /> i}N rc N 4 arzrri- <br /> 0 Zoning St s; UP; <br /> OW 1: A WS (N r,Street,City,State, ip) <br /> e �',N Deed Re • n; CSM <br /> a HO E HONE CJ CELL PHONE —E-M�AILADD'ESSfO Varianc ( ) <br /> 7- a N A ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> ENT NAME----r.... CO_NTRACTOR NAM/FF , <br /> I /nPSL`/J ({P&'N(-457-40. Lets. ❑Site Plan including location V <br /> AS DRE � 5 CS ONTRACTOR 3c)ADDRESS t of well/septic <br /> ( y�C�^ ')/ 1 „ x+ s 5,�,. ( ty, to ip) ,,�F�-, s�sg ❑Setbacks <br /> PH ErKw+l1QYY`'- l C PHON � Q ❑Site la ' proval from <br /> v 3/`I Q � F3II 0 app Ile tgWnship. <br /> E AA' ADDRESS E-MAIL ADD RS _ <br /> kW-�bMp s..�c-5 fr+4i1/1'LI .( 'c��`�U�'^Q Sul cis +ni;toi idr/4412" ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.danewi.us/) ❑ Elevation of property <br /> ARENT PARCEL NUMBER: y� CURRENAZONING: ACREAGE: <br /> PUMBER � ��'' 2.3 //[[�]�] frontage drawn to scale! <br /> TO HIP: SECTION: <br /> To'L.. 14 E '/4: St-kJ 1/4'/4: ❑ Driveway permits 0— <br /> (state, county,town)ADDR q � e � � ----,❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEIAI <br /> PROJECT ES ilPTION: 9-�� ���� <br /> rtJ ❑ Zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> X00 his project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PfkgPTIC PERMIT NUMBER: ❑ Rural Addre s <br /> FIEWER (new/e ' +'g <br /> HEIGHT IN FEET: `/ NUMBER OF STORIES: (Not including basement) <br /> �— 6 /� ❑ 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: 1 ST FL O <br /> ❑ ErosionControl permit <br /> j �� 4, TOTAL SQUARE FOOTAGE: l (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> © 5+3`' ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: 00 and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ "♦ ♦ "� ��/ rD <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ao ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes Jallo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Wes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes RNo <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? ❑Yes LNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ -4 <br /> 545-112(4/08) <br />