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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER ��NAME� ^ � I <br /> 1111 co.,eGrvt. l C. El Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Stre ity,State,Zip) <br /> I ICI4-7 �, 4(,LnAbs.� � Po. oK 2t�,g Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE /_o$ E-MAIL ADDRESS <br /> 504-G24-00,cur 31-6-272 - - •r►1.g 63 Q YQ •fin'` ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> Np1 CONT CTOR NAME lAg_. \.a ur erC'< E PcS A <br /> ^ /.L7 F ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1V4) 0, 04-Umbui Qa <br /> (City.State,Zip) (City,State,Zip) ❑Setbacks <br /> Eir_.. --r2)U W 5353 4 <br /> PHONE PHONE ❑Site Plan approval from <br /> 3c (- 2.7 2 4o applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ot.r5 (, 0 Y cok.. ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: a �,) ACREAGE: <br /> IXI PARCEL <br /> NUMBER n� J 2-32 3 qc o—7 A-2: 2-29 Acnas 10 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> At 31.0 3¢6.—12. '/4: S W %1/4: .. ltd ❑Driveway permits <br /> ADDRESS: _ (state,county,town) <br /> I t q47 3 • b4th 1 (-13CsE24 l --.3'S--.34 ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPT'RII N: <br /> -2 ZeS 1 Deocel ❑ Zoning District <br /> . <br /> This project is a new building or structure. ❑ Permitted Use? <br /> 2IThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> rEWER RrEPTIC (new/existing) <br /> HEIGHT IN FEET^ /� NUMBER OF STORIES: (Not including basement) <br /> L 1 Y2 ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 1 <br /> BASEMENT: 1ST FLOOR: ErosionControl permit <br /> 20 r 7 6) S- 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> ` filling/access) <br /> 2ND FLOOR: 3R OOR: <br /> �� . ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ <br /> (Please round to nearest dollar) ♦ ♦ c o and available options. <br /> $ 70 000. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes RINo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ®S'es ❑No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes 'iNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes jNo <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 No (Don't know <br /> 7. Is this to correct a violation? Yes �No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -I. -* -i <br />