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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME y� <br /> cam, '41,i Ord ' '1:0 C-. ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> ',i6"1. �PHONE/ (h) CE PHONE E- <br /> � Qr...,y,e-- MALADDRESS Variance(# ) <br /> HO <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONT CTOR NAME <br /> F ",vL ( U7�`S „`� ❑ Site Plan including location <br /> AGENT ADDRESS CON RACTOR ADDRESS of well/septic <br /> Ar, /07 S <br /> (City,State,Zip) (City,State, ip) ❑ Setbacks <br /> PHONE PHONE t-.i `�1�. ( Site Planapproval from <br /> ❑ PP <br /> GO g ()VC() applicable township. <br /> E-MAIL ADDRE`S E-MAIL ADDRESS • <br /> ,/c(c k c ,/,I L ( (jrl6, `.,,,, ❑ 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 /> ❑ PARCEL t frontage drawn to scale. <br /> NUMBER '/SI- ,`b — (o <br /> TOWNSHIP: SECTION: <br /> 1(:),..,,...... o SU.,. <br /> Pe%; ✓� ,/. ,/,/. ❑ Driveway permits <br /> 4. 4 4. (state, county,town) <br /> ADDRESS: <br /> ��c, `�*'^'} v✓ ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECTDES•'IPTION: <br /> t/.1/N- Li Zoning District <br /> This pro -ct is a new building or structure. <br /> ❑ Permitted Use? <br /> ❑This pro -ct is an addition/alteration to an existing building or structure. <br /> SANITARY SER ICE: PERMIT NUMBER: ❑ Rural Address <br /> SEWEREPTIC (new/existing) <br /> HEIGHT IN FEE NUMBER OF STORIES: (Not including basement) <br /> 6 ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dim:nsions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> ❑ErosionControl permit <br /> 1 TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> .3c9._69 ❑ Review Location Survey <br /> ESTIMATED ONSTRUCTION COST: ♦ ♦ ♦ -► and available options. <br /> (Please roun to nearest dollar) �V o/ U '�t3 <br /> 1. The prop y is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes lo ❑Don't know <br /> 2. Is there a etland or floodplain on or near the property? n Yes fl No ❑Don't know <br /> 3. Have you asked with the township about your project and are they in agreement? Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes ❑No <br /> 5. Is this proj ct associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a locati n survey required? (see reverse) 'es I I No ❑Don't know <br /> 7. Is this to c rrect a violation? ❑Yes gNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -p -* <br /> 545-112(4/08) <br />