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ZONING PERMIT APPLICATION ww.countyofdane.com SUPPLEMENT to Web-App # <br /> w <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNERiNAME <br /> SC IlAdt-der- ST`-Df Li"{- ❑Zoning Status;CUP; <br /> O ER ADDRESS (Number,Street,City,St e,Zip) Deed Restriction; CSM <br /> `�.12( �O o_c.2s ,� L� .� �,rJ—r- .. 1.5..e..4:1,z <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> f1■ ' °41 '""t/I111 I 4 Q . • 1.,,. 0.7 •-''i Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMA►:ON C- nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ,---t 6.-3,e 2 . v✓: 1 ( ..-c.;--cc0,--e_. (1.9,5 „`.-1-- ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 5t'h"„2._ - (,,,s-ct-7 Cj..„‹.)cL- ) . <br /> (City,State,Zip) (City,State Zig) � ❑Setbacks <br /> w <br /> PHONE PHONE ❑Site Plan approval from <br /> bp& — (o_ ,(,UIr applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> —Flu M e.s En - Ids,,, <br /> j1 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) .]. va <br /> PARENT PARCEL NUMB`�ER�:- c� CURRENTTZONING: ACREAGES: ❑Elevation of property <br /> ❑NUM ER o6ors^ �J�` eo-S- C_ Z 3j / y frontage drawn to sCale. <br /> TOWNSHIP: SECTION: <br /> f'tr, ' �' .-A 3S '/.: SA- '/a'/4:sw ❑ Driveway permits <br /> ADDR SS: S (state,county,town) <br /> (p5 1 ti c „dit cLr 4,11-.1 .,.,lot, <br /> CSM: LOT SUBDIVISION 3 BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> gSTAFFuREVJE1* <br /> PROJECT DESCRIPTION: e t! i f t ,..e-(-C S{.. e: 1, ❑ Zning Distnc ,t <br /> . ®This project is a new building or struct re. <br /> ��,� �ertxittte�Use? <br /> ['This project is an addition/alteration to an existing building or structure. <br /> ❑ RuralAddress ` <br /> SANITARY SERVICE: �P�,� PERMIT NUMBER: �� ,� �� T <br /> EWER [EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ice e_.-e. I -Li Wetla n d/Floodplain/ <br /> •AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) •" o t£ r :mi <br /> BASEMENT: 1ST FLOOR: <br /> ErostonControl permit <br /> 1 t 12> TOTAL SQUARE FOOTAGE: sb es,� rbance <br /> —'`� tw Fill ng/access] f , <br /> 2ND FLOOR: 3RD FLOOR: . ; .f '��1` `N <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ""`"`� t <br /> (Please round to nearest dollar) ♦ ♦ '� 1(00, �d and avai able options <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ENo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes JNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? EYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? FC Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ❑No MDon't know <br /> 7. Is this to correct a violation? ❑Yes QNo <br /> /t/. AS APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) 9 —► —► <br />