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ZONING PERMIT APPLICATION .countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAM3-71 E M�� <br /> i ` ' L r'<- 1 e' Q',,' ''''� El Zoning Status;CUP; <br /> OWNER ADDRESS (Nu Street,City,State,Zi P'O. (� —� �rcS+ II r 5-35 --- Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILAD•RESS <br /> 7 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRA*TOR NAME <br /> Ow ' ID Site Plan including location <br /> AGENT ADDRESS CONTRA•TORADDRESS of well/septic <br /> (City,State,Zip) (City,State Zip) ❑Setbacks <br /> PHONE PHONE . ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) e <br /> Elevation of properly <br /> PARENT PARCE UMBER: URRENT ZONING: ACREAGE: p p y <br /> 0NUMBER , I d�1. —1z-et/so 1 res, Pk''')- "f" 2 iCacee5 frontage drawn to scale. <br /> TOW+N•j�HIP: SECTIO n/ <br /> W I�( Sp,� / ) 5f 1/a: JV h/9 '/%: ❑Driveway permits <br /> ti (state,county,town) <br /> wn) <br /> ADDRESS;_[/ "- 1 5 V) C W dr�✓ k [3 Sanitary permits <br /> CSM: LOT <br /> V SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF RERIEw <br /> PROJECT DESCRIPTION: / L <br /> 1 I/ v V - ❑ Zoning t7i try <br /> . This project is a new building or structure. <br /> Ci PerinlftKed <br /> ❑This project is an addition/alteration to an existinc building or structure. <br /> SANITARY SERVICE: PERMIT NJMBER: Q Rural Address <br /> EWER FIPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> p- I S-4.k-. / U VIletiandffloodolainS <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 13�31i <br /> L-� 2 � 2 , TOTAL SQUARE FOOTAGE: j (slopes,d�uI nce, <br /> 2ND FLOOR:— 3RD FLOOR: y Wing/access) <br /> -.4ri---6../...g...2".:./ <br /> U Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: $ �/J� Q�� available options. <br /> (Please round to nearest dollar) ♦ ♦ -�► -�► -0. ♦ Z` /Do <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Res (% . Ron't know <br /> 2. Is there a wetland or floodplain on or near the property? ' o on't know <br /> 3. Have you talked with the township about your project and are they in agreement? es • • <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 6 o <br /> 5. Is this project associated with a rezone/CUP/varian - •- "a•n/appeal# ) (leav blank if none) <br /> 6. Is a location survey required? (see reverse) es o �on't know <br /> 7. Is this to correct a violation? Dyes to <br /> ig-/ I /T-- APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ —► -4 <br /> 545.11?(4n1A1 <br />