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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> D a I e -4 Laura. awn P 11 r e y D Zoning Status; CUP; <br /> OWNER ADDRESS Number,Street,City,State,zip) ^AA Deed Restriction; CSM <br /> 1( Fox.r01 Tr /V d 164' l 53-71-7 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL•'DRESS <br /> ,b$- S'- 2S3 dal- ®d!chum •tire y. con, D Site Plan drawn to scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONT-'CTOR NAME <br /> Sek t, w la , I•I.I.�d e rs Sc win * Builders D Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 7 gl� Food 1P rd Tr 7g .1 ',Obeid Pond 7r <br /> (C State,Zip) (Ci ,State,Zip) D Setbacks <br /> Cross P!ait'LS W I 53S Z Cross Pk ins w I 535, 81 <br /> PHONE PHONE D Site Plan approval from <br /> 08- 798- 1760 608- 1W- 11700 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> all wln0lel)ill idersy) 600.co .Sal winglebt.t.; ider's dAtahoo,cool 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENTZ NING: ACREAGE: <br /> ElPARCEL <br /> NUMBER 03-DS- Z93-/03`I^O - I frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> M I Cid I G.j-or '/.: '/11/.: ❑Driveway permits <br /> ADDRESS: ('' (state,county,town) <br /> 7 5-Li 7 (A_v►-,. 1 1-L oQO t,(, i T i- 1 El Sanitary permits <br /> CSM: LOT LI SUBDIVISION BLOCK/LOT <br /> 07°81.-42.3'' . -. <br /> Tuwible bowl)I i l< (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: 1 <br /> Ike w home Con STYU.L Cdr LI Zoning District <br /> . <br /> This project is a new building or structure. <br /> ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER PEPTIC (3 - 2.015 - 002.6D (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES:RIES: (Not induding basement) <br /> / <br /> ❑ 1Metland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> 37 n 39 Ai c? ,l TOTAL SQUARE FOOTAGE: ,l (slopes,disturbance, <br /> �G 7 ' filling/access) <br /> 2ND FLOOR: 3RD FLOOR: ?Ili <br /> ❑ Review Location Survey <br /> ESTIMATED ED CONSTRUCTIO NCOST -► -► -► ��C q o and available options. <br /> (Please round to nearest dollar) h J <br /> 1. The property is within 300 feet of a stream or 100 feet from a pond or lake? DYes a'Jo DDon't know <br /> 2. Is there a wetland or floodplain on or near the pro erty? Dyes o DDon't know <br /> D <br /> 3. Have you talked with the township about your prof ct and are they in agreement? Yes OIo <br /> 4. Has there been a zoning permit issued for this pr perry in the past 5 years? Dyes aio <br /> 5. Is this project associated with a rezone/CUP/varia ce(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) DYes ao DDon't know <br /> 7. Is this to correct a violation? DYes CKINo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► ♦ -► <br /> 545-112(4/08) <br />