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• <br /> ' ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> I)ri n 4t L4v4(I ft), kr Q <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 0 Zoning Status;CUP; <br /> 1 c Pt`l< y qv'? to., w.- 5 3 5-3 y Variance Restriction;CSM <br /> HOME PHONE CELL PHONE -MAIL ADDRESS Variance(# ) <br /> 0q -y34-6/34, <br /> AGENT INFORMATION I CONTRACTOR INFORMATION ❑Site Plan drawn to scale <br /> AGENT NAME and includes dimensions <br /> CONTRACTOR NAME <br /> Pcfc S^^ion G o:.I 51,2 Cc tl.41 ring El Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> 1 V 7 II G n Kr D of well/septic <br /> (City,State,Zip) t.C'>QI�'isle C /[ <br /> (City,State,Zip) El Setbacks <br /> PHONE Orfgvwh i w T S'C3 //5 <br /> PHONE q 3 El Site Plan approval from <br /> E-MAIL <br /> /) a 72 3 L/2-7 Z applicable township. <br /> E-MAIL ADDRESS <br /> El Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> ElPARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: El Elevation of property <br /> PARCEL <br /> NUMBER 5-./ 'X 1 y (9 3/S(--6 fit.2 r 4) / y frontage drawn to scale. <br /> TOWNSHIP: SECTION: V <br /> 14 1 h{to PI .11 1/4: S g- %I/: SE ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> Lo+ ,, 5 7 PC Adc 14.% ystaovlslo diet foiBL WZ c5(-351 �Sanitary permits <br /> CSM: LOT OCKJLOT <br /> o d (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION_:f STAFF REVIEW <br /> /Li 0`t 6a S yh / t 4 ,Yt I I r YID vin <br /> D' ❑ Zoning District <br /> • ®This project is a new building dr structure. <br /> ❑This project is an addition/alteration to an existing building or structure. C3 Permitted Use? <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER PEPTIC (new/existing) <br /> HEIGHT IN FEET i NUMBER OF STORIES: (Not including basement) <br /> ' S / crir t y ❑ Wetland/Floodplain! <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionConirol permit <br /> I`i°0 4frif 2 ?m 0 j TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> filling/access)2 : 3RD FLOOR: s L Q p,y.>/ 0.0 my ( D sir ❑ Review Location o <br /> n Survey ESTIMATED CONST RUCTION COST: <br /> (Please round to nearest dollar) "∎ '∎ ♦ -I• -I. -► $ /75'a b D and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Elves DR) <br /> ro <br /> 2. Is there a wetland or floodplain on or near the property? ['Don't know <br /> p � es o �on't know <br /> 3. Have you talked with the township about your project and are they in agreement? V1'es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ElveSo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# <br /> 6. Is a location survey required? (see reverse) ) (leave blank if none) <br /> Elves o DDon't know <br /> 7. Is this to correct a violation? <br /> Elves o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(sros) Zi 0 (Continue on Back) -► -i -. <br /> s� <br /> ---Z:B. <br />