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ZONING PERMIT APPLICATION www.countyofdane.com =3=7 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> a r �Y 6i / p I- ['Zoning Status; CUP; <br /> OWNER ADDRESS (Numbe <br /> Street,City,State,Zip) ,/) _,t 1/0-575.3 Deed Restriction; CSM <br /> le) 2 a /1 £?c 'r/Uri / Variance(# ) <br /> HOME PHONE CEL PHONE E-MAIL ADDRESS <br /> 60,111/3 9s3/ 'trc, S ,1 ' q// ' a hey.cJ.4i ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTR'CTOR VAME w <br /> 'W C.'r*'i g(.l )�CI>r►9s ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRES of well/septic <br /> _2-&-'2 h2 Aa' <br /> Po, 3ec ?J' <br /> (City,State,Zip) (City,State,Zip) � <br /> Setbacks yart0t, T 1 ,6/c w <br /> PHONE PHONE <br /> El Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> ; e)/A.P✓--t" i(} SA Nre)& r1;'11 4ui ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 111 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PNUMBER ARCEL J-/e)- /q/, WO-t:2 frontage drawn to scale. <br /> TOWNSHIPS SECTION: <br /> 9/ij <br /> / ,/4: ,/4,/4: ❑ Driveway permits <br /> (state,county,town) <br /> ADDRESS: <br /> —7,) 7 r�G/� � .�� ' /J('( ['Sanitary permits <br /> CSM: LOT SUBDIV ION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: /oy. e, rlc / G �,r e",/,, ►),s� <br /> JJ�C I % ❑ 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. l <br /> SANITARY SERVICE: PERMIT NUMBER: U Rural Address <br /> EWER [EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> _l Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOO'R: ❑ ErosionControl permit <br /> WO v + TOTAL SQUARE FOOTAGE: ,, (slopes, disturbance.. <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: ,�f D O <br /> vX Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ■ -, ♦ ♦1 $ / , �4/- and available options. <br /> (Please round to nearest dollar) / <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ViNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Des ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes MNo <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 ❑Yes No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes to <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -+ -► <br /> 545-112(4/08) <br />