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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNV R NAME n <br /> Ji-- ,1� ktd Z ❑ Zoning Status; CUP; <br /> OWNER A REE`SSS (Number,Street,City,State,Zip) �,�A`', Deed Restriction; CSM <br /> HOME ONE � CELL PHONE E-MAIL�ADRESS �� Variance(# ) <br /> D7476 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGE AT NAME CONTRACTOR NAME <br /> , t' 5 4�EI t 1, /6a6SC- n 4&/l band ❑ Site Plan including location <br /> AGEN DDEES CONTRACTOR DRESS of well/septic <br /> -2o0 a r 6'rd- . -ice t/.6/Se <br /> (Ci ,State,Zip) (City. te,Zip) ❑ Setbacks <br /> RIC/0/ kr 4)/ a6-6o if & ? 7 /•5 <br /> PHONE / P E ❑ Site Plan approval from <br /> Cj ) 44-4-6 38a .)e - /•- 66.5 J applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: ❑ Drivewa ermits <br /> l�' ��pIJ�. '/a: '/a'/a: (state,county,town) <br /> ADDRESS: n /� /� <br /> /86 9 ()m /94r j 66 �f'arAid'id 6 65". 1 ❑ Sanitary permits <br /> CSM: LeT SUBDIVISION 1 BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION , STAFF REVIEW <br /> ■ <br /> PROJECT DESCRIPTIONtA /f .1 p/ „ - / Crlf/'� i L 40 I�I'�1� <br /> , .11ee,� arch 4c h7'c ll (Yaw /i/i, Cdr '�Ci�Si7'hq ier]+ii ❑ Zoning District <br /> . ❑This project is a new building or structure. J ❑.;Permitted Use? <br /> 03 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address z <br /> ❑SEWER ®SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 0/7e--- ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> la BASEMENT 1ST FLOOR: "ErOS1onCOntrol=perrnit <br /> ii3yQ /6 4, TOTAL SQUARE FOOTAGE: ,IF (Slopes,disturbance, <br /> 7dG�`(CJI filling/access) <br /> 2ND FLOOR: 3Rij"FCt96R: �� Le ��� <br /> (' ❑ Review:Location Survey <br /> ESTIMATED CONSTRUCTION COST: �J�( and available cipti0ns <br /> (Please round to nearest dollar) ♦ ♦ ♦ --► ♦ ♦ $ `V)d z r <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes KI No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes igi No ❑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 /> 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 /> (Continue on Back) ■ —► —■' <br /> 545-112(4/08) <br />