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ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> CARL PIM 1'- 4K <br /> OWNER ADDRESS (Number,Street.City,State,Zip) � / �� ( O Zoning Status;CUP; <br /> ( }( $ LA-8 t--),,hg-- ( v , SIT-T5— Deed Restriction; CSM <br /> HOME PHONE I,CELL PHONE E-MAIL ADDRESS Variance(# ) <br /> Z62 —L3-.-`P6sr RIArvt 4(14 IK @ C ''t4-1L, tom <br /> AGENT INFORMATION CONTRACTOR INFORMATION ❑and includes drawn to sion <br /> AGENT NAME and includes dimensions <br /> CONTRACTOR NAME <br /> AGENT ADDRESS 0 Site Plan including location <br /> CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) <br /> ❑Setbacks <br /> PHONE PHONE <br /> ❑Site Plan approval from <br /> E-MAILADDRESS applicable township. <br /> E-MAIL ADDRESS <br /> O Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> 0 PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE El Elevation of property <br /> PARCEL <br /> NUMBER o2$/0610.—• 32t gyta-0 /1--j E-y (S • 6 frontage drawn to scale. <br /> TOWNSHIP: <br /> Ow SECTION: <br /> N O pU N N 3 2 <br /> 1/4: N E /a/a: S E- 0 Driveway permits <br /> ADDRESS: (state, county,town) <br /> csM: LOT <br /> SUBDIVISION BLOCK LOT El Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: STAFF REVIEW <br /> /�-(3 /Z(CULi-0(LA-L Bot LP/0 <br /> ❑ Zoning District <br /> This project is a new building or structure. <br /> OThis project is an addition/alteration to an existing building or structure. ❑ Permitted Use? <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 2 •S ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) I-77 <br /> BASEMENT: 1ST FLOOR: <br /> 1—.i <br /> EfOSIOnCOntr01 permit <br /> logo ,, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR 3RD FLOOR: filling/access) <br /> ( 0 8 o ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ -► -► ♦ and available options. <br /> (Please round to nearest dollar) O 0 . 00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Oyes ao ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? <br /> 01'es ONo ODon't know <br /> LzS1� <br /> 3. Have you talked with the township about your project and are they in agreement? es No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Oyes ao ? 2 <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# <br /> (leave blank if none) <br /> 6. Is a location survey required? (see reverse) <br /> Oyes No ODon't know <br /> 7. Is this to correct a violation? <br /> aes EINo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -i -0 -0 <br /> 131 <br />