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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to'Web-App # <br /> PROPERTY OWNER INFORMATION ' CU-T MER TO PROVIDE <br /> OWNER NAME . c � <br /> , <br /> SCO A ✓ 144"l` S Z .ng Status; CUP; <br /> OWNER ADD S ,,(ttNumber,Street,City,State,Zip) „/ /�i} / CS�VI <br /> .41 �I + �(r� � �� W � ance(# ) <br /> HOME PHO E CELL PHONE E-MAILf'•DRESS <br /> W--516 -&56 ? __cc h i,, .S 4g-ft/mils avnsfMditm • (6 11 Ste Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> mite Plan including location <br /> AGENT ADDRESS CONTRA TOR ADDRESS !of well/septic <br /> (City,State,Zip) (City,Stat ,Zip) Fl Setbacks <br /> PHONE PHONE n ite PI approval from <br /> p. able towns . . <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> . Floor pl to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.ciane.wi.us/) Elevation of property <br /> PARENT PARC L UMBER: CURREN NIN ACREAG : p p y <br /> n PARCEL 4 Jo-] 2 _IO/_c coo—/ ,, G frontage drawn to tale. <br /> NUMBER .1)c:TOWNSHIP: SECTI. � <br /> i' 1\ it 1: i ` ,/W/: �vJ ❑ Drivew ermits <br /> ADDRESS: �7 I , l (state,county,to n) <br /> 4445 in;CSOuf t Rd To.i,Sha1,1 W tM f� <br /> CSM: LOT SUBDIVI'ION BLOCK/LOT I I Sanitary . rmits <br /> (publi .rivate) <br /> PROPOSED PROJECT INFORMATION TAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> • e VI k iA .] Zoning District <br /> , I <br /> Li project is a new building or structure. U Permitted Use? <br /> This project is an additio alteration to an existin• building or structure. l <br /> SANITARY SERVICE: PERMIT UMBER: U Rural Address <br /> nSEWER SEPTIC - (new/existing) <br /> HEIGHT IN FEET: ( NUMBER OF STORIES: (Not including basement) <br /> /2 <br /> Wetland/Fioodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached gauges and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: -J ErosionControl permit 3,e�1 <br /> 4, TOTAL SQUARE FOOTAGE: ,+, (slopes, disturbance, <br /> 2ND FLOOR: 3RD FLOOR: )))•J\ <br /> filling/access) <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: Q� (� 1 and available options. <br /> (Please round to nearest dollar) ♦ ♦ --0 ♦ ♦ --► $ v <br /> t <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Y No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? es ❑❑Nj� n Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes ❑ o, <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Ill ' <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) (leave blan i none) <br /> 6. Is a location survey required? (see reverse) ❑Yes o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> c)1" (Continue MUST BE SIGNED <br /> (Continue on Back) -4 <br /> 545-112(4/08) <br /> et', <br />