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0 zc <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> ow�R NAME / y ( g <br /> / ❑Zoning Status; CUP; <br /> O RADDRESS (+� .er,Street, ty,State,Zip) <br /> �11� # , I�"` lixt 'mob ç [V Deed Restriction; CSM <br /> Variance(# ) <br /> HO E H NE ' ELL PHONE E-MAIL ADDRE S (,, <br /> •'g 3 , f C rt4 ;s m ' `�G - il f 'S.ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME ��� _ <br /> ❑Site Plan including location ff <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ■ <br /> (City,State,Zip) (City,State,Zip) in Setbacks 'i— '- ✓u/ --' 'Y"t <br /> �. ,-7\tACv( <br /> PHONE PHONE ❑Site Plampla val from <br /> applica�Ielto hip. <br /> E-MAIL ADDRESS E-MAIL ADDR ESS <br /> ❑Floor plans to scale <br /> / PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) , <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property '/ <br /> ❑PARCEL 0`j0(� -�'e2-(o 02—1190 -Q �#_ frontage drawn to scale._ <br /> NUMBER <br /> TOWNSI{^IP'[� SECTI � - <br /> �V /4: /�f` /4/4: 3W Driveway permits Not-1,142_� <br /> ADDRESS: � 1`Na �J- Alt+_ ��,r^� 53C-q9-(state,county,town) ,_ '-Li t Sanitary permits <br /> s LOT SUBDIVISION BLOCK/LOT (public, private) ` At. ' r20,$-\ <br /> PROPOSED PROJECT INFORMATION TAFF REVIEW <br /> PROJE T D �CRIPT�ON. -J <br /> ��`�(l 4CC Or Gar.V'e,Ar1"ec� + SC2 ❑ Zoning District <br /> ❑This project is a new building or structure ❑ Permitted Use? <br /> jaThis project is an addition/alteration to an existing buildinq or stntctilre, <br /> SANITARY SERVICE: PERMIT ER's ^ ❑ Ru .I Address <br /> EWER rl(6EPTIC —2e`� existing) <br /> HEIGHT IN FEET J` ������ : (Not including basement) <br /> ❑ Wetland/ I>�t,.. in/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shorelan. . • ment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: i ❑ Eropes,di ntrol permit <br /> r4 + TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> j8 4 0 --- ----- <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: _ _ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ ��0 �av <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes r o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? rh es I. o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? �h es ❑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) ► 1 es alo ❑Don't know <br /> 7. Is this to correct a violation? Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4l08) (Continue on Back) -+ ■ -* <br />