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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 /> e -' a_s 7 ' l Q- uC∎ i a s ❑ Zoning S s; CUP; <br /> OWNER ADDRESS (N �er,/$treet,City,State,zio) Dee estriction; CSM <br /> C/ �cUes e �i�. � �/.��/celeeta/ee Lc�. C:. 5'-`3 % Variance(# ) <br /> HO 4E PHONE , CELL PHONE E-MAILADDRESS <br /> ac._ 4, S <br /> -tia �— $ A S' a Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTR/i■CTOR AME <br /> 2 £ s7,7/ l Sit Plan including location <br /> AGENT ADDRESS CONTRRACTTO AD ES o well/septic <br /> e <br /> (City,State,Zip) (City, ate,Zip) _ _ Setbacks <br /> PHONE PHONE ❑ Site Plan royal from <br /> 2 2 - 00 2 v pplic�.able township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> Fl or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> PARENT PARCEL NUMBER: CURREAT ZONING: ACREAGE: , / P p y <br /> ❑ PARCEL G��(� c29_4 0— 2 �/1..._ 5, L.� frontage drawn to sc . <br /> NUMBER O 7 V J ///��� <br /> TOWNSHIP: SECTION: _ <br /> `" I�4a!�G_( _ 1414: S k- ❑ Driveway Its N ,ADDR S: ���� ) (state, Unty,town) <br /> / 1 ' I <br /> - ❑ Sanitary p its <br /> CSM: LOT W d BDIVISION BLOCK/LOT (public rivate) <br /> 7 ., <br /> PROPOSED PROJECT INFORMATION /STAFF REVIEW <br /> PROJECT DESC IPTI t• �l ' 'I' <br /> -a - CJ'l 0 Co v c f ` 1 a •W U( )It ' 1:149iiing District <br /> . ❑This project is a new building or stlructure. T i ..k.- o. , j <br /> ermitted Use? <br /> Ul This project is an addition/ Iteration to an existing building or structure. %--� <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural defressi <br /> ❑SEWER SEPTIC (new existing , <br /> HEIGHT IN FEET: 1 0 / NUMBER OF STORIES: (Not inclu(l ding basement) <br /> ❑ Wetland/Flaodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shore rid (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: iSTFLOOR: / I—, ErosionControl permit <br /> 11�z 4, TOTAL SQUARE FOOTAGE: 4, (slopes, disturbance, <br /> cteSs) <br /> filling✓✓ <br /> 2ND FLOOR: 3RD FLOOR: <br /> Ci)� ❑ Revie w Location Survey "`� <br /> ESTIMATED CONSTRUCTION COST: y <br /> Q I/ IY1© and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ 11 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a and or lake? ❑Yes if ❑Don't know <br /> P PrtY pond <br /> Is there a wetland or floodplain on or near the property? ❑Yes ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) (leave blank f one) <br /> 6. Is a location survey required? (see reverse) Li Yes O CI Don't know <br /> 7. Is this to correct a violation? DYes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4i08) -'.14 CO . <br />