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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 /> /f r4'v ) h✓r'" n Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 7 6 s 3 T, '- L-44 (c '7" G'‘.,-,--1,k, h� S 3S-9 3 Variance(# ) <br /> HOME PHONE CELL PHONE/ E-MAIL ADDRESS <br /> A.' 'A &'W'S_ 06, chair k.hx. f-u) . ,H,,„ / c -, ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Et an bss4." <br /> , ,/..7 X14 /„�;fr.{ t-L(- I ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE V eirvAcfI <br /> HONE PHONE <br /> n Site Plan approval from <br /> (7c —6 i -.—Scf 7`t applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 4 /via, ��� ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> El <br /> PARCEL frontage drawn to scale. <br /> NUMBER <br /> 4 --1- 7�C, ronta g <br /> TOWNSHIP: SECTION: <br /> All4,,CR44410.// 1h: ,/4,/4: ❑ Driveway permits <br /> ADDRESS: (state, county,town) <br /> 7633 T•cier /-14.7 C,..,,--/- <br /> �,..,�' C','�,‘,, w� 535- (/3 <br /> 7 El Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT r -C, 140110w (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Z) K_ ❑ Zoning District <br /> ❑This project is a new building or structure. ❑ Permitted Use? <br /> ®This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> nSEWER MSEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ 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: 1ST FLOOR: <br /> ❑ <br /> Li permit <br /> 1 TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 't6) ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) ♦ '♦ ♦ '♦ ♦ '♦ , and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ® No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? n Yes 71 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? 12.c, s ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es n No <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) (leave blank if one) <br /> 6. Is a location survey required? (see reverse) ['Yes t� n Don't know <br /> 7. Is this to correct a violation? ❑Yes loQ <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) - -♦ <br /> 545-112(4/08) <br />