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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME / yC <br /> Tffe" vd!°•" / sow <br /> ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Streej,City,State,Zip) <br /> Deed Restriction;CSM <br /> 7s ex b S V!" e^ e e,, ^1egiS ps, s3 s'73 V # ) <br /> HOME PHONE CELL PHONE E-MAILADDF�ESS A Alt y/ <br /> Jr, a -�°3 9 T/Q o 6e 9`�5✓ti�� ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGE ME CONTRACTOR NA^jj <br /> Om 1>!S tigl-, 1-1"es.ete. 1 c L ;4 'V We/441 ❑Site Plan including location <br /> AGENT ADDRESS Y CONTRAtTORADDRE of well/septic <br /> d 9 Co C,7A 1-/ <br /> (City,State, n b w� 37/� (City,stag,Zip) ❑Setbacks <br /> G�/1. <br /> PHONE P/ PHONE , ( ❑Site Plan approval from <br /> E-MAt(6,196)&"S �O — 6 3Y'/ E-MAtLA� ( ` applicable township. <br /> ,! DRESS <br /> TTO a+? 4 l erg hO es.. ,. .4- « ' e/ ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://acc:essdane.co.dane.wi.usI) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: <br /> PARCEL 3u O >4 f e7g///a frontage drawn to scale. <br /> NUMBER D70�-�'O T O`I/� I / <br /> TOWNSHIP: / SECTION: <br /> " {/ ' ' 1/4: %IA: ❑Driveway permits <br /> ADDRESS: / (state,county,town) <br /> , ❑Sanitary permits <br /> CSM: LOT SUBDIVI ION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: A _�¢ <br /> Ne w �/ /4eei`.Y" S f H ❑ Zoning District <br /> . is 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 /> EWER ›°°°°°° EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Ftoodplain/ <br /> " D °� Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ❑ ErosionCOntrol permit <br /> BASEMENT: /4/7/ 1ST FLOOR: <br /> GI , + TOTAL SQUARE FOOTAGE: j (Slopes,disturbance, <br /> filling/access) <br /> 2ND 3RD FLOOR: q 3 l & .- 3 / 3 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ -�► ♦ 7 _ and available options. <br /> (Please round to nearest dollar) ,j ,T1 Q <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies to ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 0: • ❑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? ['Yes [ 40 <br /> 5. Is this project associated with a rezone/CUP/variancce(petition/appeal# ) (leave bl if none) <br /> 6. Is a location survey required? (see reverse) es alo ['Don't know <br /> 7. Is this to correct a violation? [Yes pto--- <br /> / _s ' q APPLICATION MUST BE SIGNED <br /> (Continue on Back) • -, -► <br /> 545-112(4/08) <br />