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- ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> ovp.SR NAME / <br /> O/lQ �� �ouY Ne oning Status; CUP; /4 --*/O ADDRESS (Number,§treet,City,State, ip) Deed Restriction; CSM <br /> WN 8712 Za`t/e4- ©ii1 e Variance(# ) r rii <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS <br /> 60-61-437-b"t57 M Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION _nd includes dimensio WI- <br /> Site AGENT NAME CONTRACTOR NAME Plan including locatio , <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) KSetbacks l(511�55�1�3/7 ,o//114/ <br /> / <br /> PHONE PHONE <br /> ite Plan approval fro /Q <br /> pplicable township. <br /> �� <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ;d Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT F7 RRE TZON G: ACREAGE: Oil levation of property <br /> [=I PARCEL NUMBER I r/ / frontage drawn to scale. <br /> TOWNSHIP / SE •N S (ra r / ‘t Z 1/4: �//V %Y4, w i/'Driveway permits <br /> / ,^ tate,county •r <br /> ADDRESS: I C y b K <br /> 52 / 2 <br /> CSM: LOT SUBDIVISION BLOCK/LOT /Sanitary •- alts <br /> (public,' <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: / X / 1 STAFF REVIEW <br /> 2- 3(P /� ! '/ 0 MW/ !a Zoning District ''� <br /> 2This project is a new building or structure. :a Permitted Use? / <br /> This project is an addition/alteration to an existing building or structure <br /> SANITARY SERVICE: , , <br /> / PERMIT NUMBER: /L RurafA. _-' _ <br /> EWER / 4E/PTIC //,r Me - =tin. // <br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not including basement) / <br /> l Ketland/Flaodptainf <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 /> 2 'ErosionControl permit ® /. <br /> 1 TOTAL SQUARE FOOTAGE: 4, lopes,disturbance, <br /> fillinglaccess) /r <br /> 2ND FLOOR: 3RD FLOOR: ZS ZAIr-- <br /> (/ Review Location SUrvey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ff iand available options. /(Please round to nearest dollar) / O�Q/ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes r:!INo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes i-lirlo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑No <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 ENO ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(8/09) (Continue on Back) —► <br />