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- 31,1 1 <br /> 'ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> GOIG-L-1 k F\4:)&LOPS Zoning Status; CUP; <br /> NER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 4310-t 5PtIT14 1j • / DEEEFIELDI L L• 6-55-3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6'o 76'1 ggo4 — 17 ro�lcfs n.terr,cyl~n <br /> ® ► Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Set -S Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> /(City,State,Zip) (City,State,Zip) M Setbacks <br /> v PHONE PHONE ❑ Site - : approval from <br /> ap: icabl a ownship. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> „fair Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ! Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING:(http://accessdane.co.daAnceR.EWAGLELIS/) p y <br /> ❑ PARCEL o7/2-og2. —qi c'o -$ A -Z S,5 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTIO : <br /> D ' a ermits <br /> DECRFtELD 1%: v' 1/at/a: ❑ stat town) <br /> ADDRESS: +r- r' ( ty,town <br /> y�1� �j►►'ll l r. DPI t �X t X35 3 ❑ Sa'la •ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 4 10 2.. (pub i'. o rivate) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPT N: ,s��; ' RE tE� t <br /> (vie. ' .Lt(�i 60 Lo x6)31_ K 14 ti Zoning Distric : " e <br /> . KiThis project is a new building or structure. <br /> A,Oertnittqd::,p§led .':;,,,,,;;,? .. <br /> d <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ur ' S s% <br /> ❑SEWER LI SEPTIC ' ( -w/exl s rt <br /> HEIGHT IN FEET: i NUMBER OF STORIES: (Not including basement) <br /> 23 <br /> p' -� 1 Li`Wet) •l is s,lain <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shore '® (attach ment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1 ST FLOOR: .Erosl s s .l ® t <br /> a' <br /> \/ — 378r) ,, TOTAL SQUARE FOOTAGE: j (slope •' 3 rba ,"" <br /> 2ND FLOOR: 3RD FLOOR: W0 <br /> filling/ <br /> Zf <br /> ❑ Review tart Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ --► ♦ ..* $ 2-( 000 and a e options I(Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No Cl Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes CNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes l7'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 QNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes a o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ -s -► <br />