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V► <br /> t <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ,(,, <br /> X 2tctI ❑Zoning Status; CUP; <br /> OWNEk ADDRESS (Number,Street,City,State Zip) <br /> 7798 /u(rIA, 'POrtict —re c._ Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 603 3 (9O8 335--5"avg.. ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AG T NAME CONTRACTOR NAME <br /> V / - ' ri - / l-iaLL-1 t°1( Poo is ❑ Site Plan including location <br /> AGENT ADDRESS/,G 7h4e'd CONTRACTOR ADDRESS of well/septic <br /> 1 TIC 3618Coc,t,y /16 <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> 0/114Yo w(wi s- 37) ? <br /> PHONE PHONE ❑Site Plan approval from <br /> &DO-2 Z2 —/7 2 D applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> i11°110 4' ,,u.U oo(c. Cora-. ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLus/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ElPARCEL / frontage drawn to scale. <br /> NUMBER 056/019e'B�3✓��r OI^© J�-�/a I,G�� <br /> TOWNSHIP: SECTION: <br /> (0 0-$1.5c(elc{ '/,: /4./4: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 77413 Ai+.'rw,u QaiNkC DI ❑ Sanitary permits <br /> CSM: LOT / SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION <br /> STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 20 X LiO' I u <br /> :. 02.60, d' deAil in ,ti z VoO C_, ❑ Zoning District <br /> . [+'rThis project is a new building or structure. ? <br /> ❑ Permitted Use.. <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> [EWER EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ WetlandlFloodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> e + TOTAL SQUARE FOOTAGE: j tslopes ,disturbance, <br /> fi <br /> 2ND FLOOR: 3RD FLOOR: QQ lling/acceSS) <br /> G�' <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) Cj Q, L-' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Byes No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ENo Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes ®No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No 1701st Kr"'O' <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#4/(0338" ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes gNo ❑Don't know <br /> 7. Is this to correct a violation? nYes No <br /> 1 APPLICATION MUST BE SIGNED <br /> 1I (Continue on Back) ■ —► <br /> 545-112(4/08) <br />