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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 /> - d u)n o f w I n As o r ❑Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM
<br /> V yo y U�1�"�' Pc/ Variance(# )
<br /> /HOME PHONE I CELL PHONE E-MAIL ADDRESS /-( E a LiJ/ CZSd c tJ v V ❑Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME /I CONTRACTOR NAME
<br /> Tlmv ,nd0 r.so f Sc.G►�ep 5�`�.Q__ ❑Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> YO E' y Movikr Q
<br /> (City,State,Zip) (City,State,Zip) ❑Setbacks
<br /> \/ berresf W= 5353,
<br /> PHONE PHONE ❑Site Plan approval from
<br /> (900 ,,e1( - 3 85Y applicable township.
<br /> 'E-MAIL ADDRESS E-MAIL ADDRESS
<br /> t C: w)Y1 36 W�. Q ❑Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/)
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property
<br /> ❑NU
<br /> NUMBER 06irlrY1/0 a23?sa to 113 r.a , R3 i5. 97 frontage drawn to scale.
<br /> TOWNSHIP: ' / SECTION:
<br /> \ ,� T W n 0( W ;,•l(A S r-), – 14: IRA: ❑Driveway permits
<br /> V (state,county,town)ADDRESS:
<br /> yo cI r4,,'t II 4' c kc( �� � � �o t,- 12{
<br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits
<br /> _ — --� — (public,private)
<br /> PROPOSED PROJECT INFORMATION STAFF REVIEW
<br /> PROJECT DESCRIPTION:
<br /> it St119-e 215.g f add c CisSSinn Sicz.,-1 ❑ Zoning District
<br /> ❑ hT is project is a new building or structure. OA r;/-e iria-ri s P9-^- - ❑ Permitted Use?
<br /> ]This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address
<br /> EWER 1EPTIC (neW/eXiSting)
<br /> HEIGHT IN FEET: NUMBER pF+STRIES: (Not including basement)
<br /> ',V1 I ❑ Welland/Floodplain/
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> Shoreland (attachment)
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)
<br /> BASEMENT: 1ST FLOOR:
<br /> ❑ErosionControl permit
<br /> I —71 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance,
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> / filling/access)
<br /> ❑ Review Location Survey
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ • //,, and available options.
<br /> (Please round to nearest dollar) $ ion Uv V
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes alo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? NJYes _ UN0
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Efres `Eallo
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave lank if none)
<br /> 6. Is a location survey required? (see reverse) ❑YesIo ❑Don't know
<br /> 7. Is this to correct a violation? ❑YesNO
<br /> I Vli/re- u/ n 0 loot-pi,✓ti c./ ,y, ,� APPLICATION MUST BE SIGNED
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