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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU•TOMER TO PROVIDE <br /> OWNER NAME n <br /> St f V d V Z ping Status; CUP; <br /> O DD ESS (Number, reet,City,State,Zip) <br /> (aYI H w St)0 -tb n w ' J /farnce(#eed Retriction; CSM ) <br /> I <br /> HOME PHONE ■ ELL�PHONE -MAIL ADD ESS <br /> D�;� , 11 ► 11 lI` (CPA Si Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION a includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE ❑ .. e Plan a oval from <br /> ..plicab township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> IVA ' sor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: aI levation of property <br /> ❑PARCEL 00/1-Z14-%10-0 A_ Z Cr ` frontage drawn to scale. <br /> NUMBER J <br /> TOWNSHIP: SECTION: <br /> pl�asarrt Spr��/S SC '/a: Sc c. 7,1 '/e : l� Driveway permits <br /> ADDRESS: <br /> cJ (state, county,town) <br /> fc:)..... C 0 0 ,0 i /1w 11 <br /> CSM: LOT SUBDISION BLOCK/LOT VI Sanitary permits <br /> •ublic, private) <br /> PROPOSED PROJECT INFORMATION II STAFF REVIEW <br /> PROJECT DESCRIPTION: ` - , <br /> N WV Ro W B f e e > Zoning District <br /> . This 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: 1:1 :Ural 'ddress <br /> EWER EPTIC '.1 ®] ��0 OcX 7 (new/ xisting) <br /> HEIGHT IN FEET: NUMBER OF ST RIES: (Not including basement) <br /> �C� ❑ vetland/FI plain/ <br /> AREA TO NEAREST SQUARE FOOT: ShOrel (attachme <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> E N 1ST FLOOR: ❑ ErosionCOn permit <br /> BAS <br /> p b(a.s 3 7,)._ <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes turbance, <br /> 2ND FLOOR:- 3RD FLOOR: - fills access) <br /> N f ?■...1 .7. <br /> ❑ Review Location Survey , <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ O A and available options. <br /> (Please round to nearest dollar) U <br /> J <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Eve). to ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es ❑N <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies glqo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blan if none) <br /> 6. Is a location survey required? (see reverse) [Yes No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes to <br /> i ii 7s ,c <br /> %c-- APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />