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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OW^NEER_NA_ME/' C <br /> /�''�N�-` ►'� ✓)6�1 ❑Zoning Status; CUP: <br /> O NER ADDRESSS Number. reel,City,State.Zip) Deed Restriction;CSM <br /> Z44S (�a4 —�o 6, e-6Yb € 11th 53527 variance(# ) <br /> HOME PHONE j CELL PHONE E-MAIC ADDRESS <br /> 60B.$'s .$ (o 6OB Z�j'j 728 2- fr &Q d"9°)& - a"•GO�"� ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> �ecleAb C4N5 � ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS' of well/septic <br /> (City.State.Zip) (City,State,Zip) ID Setbacks <br /> 6tf� v�Vt1 5'�527 <br /> PHONE PHONE ❑Site Plan approval from <br /> 600.675.0 4o 5' applicable township. <br /> E-MAIL ADDRESS E-MAIL ADW�SS��4o�.`GOAL ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:///////aaAtccessFd—ane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> VIPARCEL 4-1u. 041. (�1 o. C R. 1 00 1 frontage drawn to scale. <br /> NUMBER I 1 TJ J <br /> TOWNSHIP: SECTION: <br /> Cp t rove— 4. 1/4: NE 1/41/4: ❑Driveway permits <br /> ADDRESS (state,county,town) <br /> Z-145 Ga54✓l n0-4 1J Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> I zzo SF Ac�lt�'iart (11 375F Rya► "1-2$3sFc ,�, ti Zoning District <br /> . ❑This project is a new building or structure. (� Permitted Use? <br /> D. <br /> ®This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER:W Rural Address <br /> EER SEPTIC (new/exiStil1t) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 3-o / Q Wetland/Floo(attachrrct itainl <br /> Shoreiand lent) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: El EroS)UnC t � <br /> /22 O 4, TOTAL SQUARE FOOTAGE: J. (slopes,di '. <br /> titting/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> /Z.2O <br /> U Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ..► d� Dl DO� and available o t1 . <br /> (Please round to nearest dollar) <br /> $ 3 <br /> .,4q5 2 f d <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or ake? Oyes ❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ? ❑Yes �(No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Eyes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ®No <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 JNo ❑Don't know <br /> 7. Is this to correct a violation? Eyes jNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) • —► <br /> 545-112(4/08) <br />