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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> wt:W.ewn 4. tra ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,zip) Deed Restriction; CSM <br /> 5628 U�7ew(,r a f 17,4✓,4-j/�adr'o ,Wi 3?I 3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6°8.22'2.5102. 44. a.4 ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> /� er 6e rj Fecieet e/'9 ConSfrdcfi s&.i ❑Site Plan including location <br /> AGENT ADDRESS J CONTRACTOR ADDRESS of well/septic <br /> 7-01,f 6-4,51-0"), goo P.O.P.0X Z-34 <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Co �e6rove )ll/.T. ' 27 Cot ro✓�, Vt/� 53627 <br /> PHONE PHONE ['Site Plan approval from <br /> 08, 2, `j.?2 '3 'Z 6.09. 575, o4o5 applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> M>n 9q°1 e.9 niad. cov2 G G IA/z 4o j...Gaye) ['Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> 7'VI MCBEELR O 7I!,O 4-1.8O/J.5 /2v1-+ lo, Z8 frontage drawn to scale. <br /> TOWNSHIP: SECTIO : <br /> Co f ce€ rr11e— ' 1h: NC %%: ❑Driveway permits <br /> ADDRESS ! (state,county,town) <br /> None <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ZbH ill Ckeµ4¢.,OM D,`T54at�RH'4 +0 R-I ; 36-4t)(4.9.1 <br /> ❑ Zoning District <br /> . I3,This project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> "SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER SEPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not induding basement) <br /> I LI Wetland/Floodplain <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: <br /> ❑ ErosionControlpermit <br /> I Zoo 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR filling/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ i i i -� and available options. <br /> (Please round to nearest dollar) <br /> R icte,r fion PvKd <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Res to ['Don't know <br /> 2. Is there a wetland or floodplpin on or near the property? es o ['Don't know <br /> 3. Have you talked with the township about your project and are the in agreement.... Yes Lo <br /> 4. Has there been a zoning permit issued for this property in the past years? ❑Yes }lo <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) - [Yes. olo ❑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 />