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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NA E <br /> J C r\. AnS-c--.\-- \._,\ ,�1 Zoning Status; CUP; A -1 <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> S S Lo L l--c :mac, _-- �\�-ra..\\ LC \ 3S Variance(# ) ��( <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> .% is D,VA:Al_v ..S. hOC r . . • t 3+•et‘S 12 Site Plan drawn to scale d/....z._ <br /> AGENT INFORMATION CONTRACTOR INFORMATION -nd includes dimensions , 1 <br /> AGENT NAME CONTRACTOR NAME C:,\ \ //J„\4 0 <br /> l��; �� 2 Site • Ing location r <br /> AGENT p ADDRESS CONTRACTOR ADDRESS Of tic <br /> 5st_Q L�.-. N, AZa■ ( 3/30/%/D <br /> (City,State,Zip) C (City,State,Zip) Setbacks <br /> \� tA� ,'cc-in.\\ u.. \ .// <br /> PHONE PHONE Site Plan approval from N 4 <br /> (t t(Y0 \'.- 1l QIS applicable township. <br /> \-.0c r\bv, ice..3\oc S-10\- 5 c, „`� '\ - Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of roe // it <br /> PARE PARCEL UMBER: CURRENT ZO NG: ACREAGE:� t/p- property rty <br /> ®NUMBER (3 .c1 O .\� - .b\-SSQ -p / i 6 t 7 d frontage drawn to scale <br /> TOWNSHIP: SECTION: <br /> a0-3 \a,t��'/a: t try '/4'/a: I Driveway permits <br /> �E c\ ^o- (state,county, <br /> ADDRESS: <br /> S S96 ,r C-\ ---`. -C.\ \Nr��S---�\--.c \ \-):-'-)\ ' at Ad I Sanitary pe 1 its <br /> CSM: LO SUBDIVISION BLOCK/LOT (public ) <br /> PROPOSED PROJECT INFORMATIONTAFFy <br /> PROJECT DESCRIPTION: <br /> Q._. :\c\:..1-,eN cj -s.aC .)..\46,:r Zoning District ; r-1 <br /> . SThis project is a new building or structure. 1 Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: fib •Rural +•+e <br /> EWER CRIEPTIC N\Ok (new I01W <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) <br /> \ 9 t \ °' ? oodplain/ <br /> AREA TO NEAREST SQUARE FOOT: l '��attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> d l,rOSUr�ntro!permit r <br /> BASEMENT: 1 ST FLOOR: (slopes,diisturbance, I/ <br /> O. X 0o 1 j TOTAL SQUARE FOOTAGE: + '+#�� e <br /> �� 0 fiIhnl+/Rrc SCI <br /> 1-A t3C0 2ND FLOOR: 3RD FLOOR: • <br /> Review LpOetio(1 Survey . ,,��� <br /> ESTIMATED CONSTRUCTION COST: -. -. ♦ -, ♦ ♦ Q and available Options <br /> (Please round to nearest dollar) $ /-∎Q C,C ' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes o ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? II es o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? % es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? pt es ❑No <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 FA;, o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes j:' o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ <br /> 545-112(4/08) <br />