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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 /> 'DA I'S— LZ,-1 i� ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> - ) 1--4105.- -ow-1 01./C:. _ Variance(# ) <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS <br /> ' '3'-6 ' 4 el A ■ieCa.04 • I r Lo,-- ❑Site Plan drawn to ale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes d' nsions <br /> AGENT NAME CONTRACTOR NAME 1 / <br /> -"Zia h C vZs b CSI na2 v,)IJ►�5 Wcip_ ❑Site PI., i • location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well -:t C <br /> ) 417i; % }-- p.v 93Q 2.2.0 )(7) 1' O6v1 , S. ._ <br /> (City,State,Zip) (City,State,Zip) ❑Set ks <br /> PHONE PHONE ❑Site Pla ._p m <br /> 64.A"c!lk-I c -at-730 21 2--2.-1'TA applica le ns ip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> v!U >:ri-Sets- ea,4 J,i p;m, ,Le,,-... ❑Floor plan scale <br /> PROPERTYILOCATION INFORMATION (http://accessdane.co.dano.wl.ust) <br /> PARENT PARCEL NUMBER: CURREN r ZONING: ACREAGE' ❑Elevatl0 Of petty <br /> ❑PARCEL L --x,NUMBER IS ti frontage r n to scale. <br /> 7 <br /> TOWNSHIP: b S T�b (q' (dot SECTION. <br /> i3 Ve)<� vl 1 UNO i c l 1/4. A l 2- ,/d/: S ❑Driv a rmits <br /> - (state ounty,town) <br /> ADDRESS: l \b L4,1- 1 hr Ai);SC") <br /> ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/L•T <br /> 'v64-c,, 1 ,e 0) (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ❑ Zoning District <br /> . ]This project is a new building or structure. ❑ Permitted Use? <br /> OThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> ❑ Rural Address <br /> EWER IEPTIC (new/existing) <br /> HEIGHT IN FEET: NUM ER OF STORIES: (Not including basement) <br /> Z�T�c� �-J 1 W) �� ❑ Wetland/Floodplain/ <br /> — Shoreland (attachment) <br /> REATO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) i-1 ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> —,. + TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> 3 2-k-,\ 4, <br /> 2ND 1LOCr l:'6( orASr, // 3RD FLOOR. �� �� <br /> m�7i7.lnM r./Fi • 1 J�11C1' <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ -+ _♦ -• $ Lf74 < 00 and available options. <br /> (Please round to nearest dollar) •p ) <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? ]Yes o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ]Yes LNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 4o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave lank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yelo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yeslo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► ♦ -► <br /> 545-112(4/08) <br />