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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> O N NAME <br /> OWNER ADDRESS (N tuber,Street,City,State,Zip) ❑ Zoning Status; CUP; <br /> \'h o -,-h-h \ \ �,..-_- \--\- Deed Restriction; CSM <br /> HOME PHONE CELL PHONE E-MAILADDRESS Variance(# ) <br /> (.rc � \ 33°\3 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> L '` "^ �' \� -� L A-C. ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> \\\\ , ■ ..--- <br /> (City,State,Zip) (City,State,Zi <br /> -\ , � ❑ Setbacks <br /> PHONE PHONE <br /> Site Plan approval from <br /> (,_ `b S'l A G\S D-, applicable township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> ❑ 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 /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER DS/Z 77H 003 i C C-0- j-cl l <br /> TOWNSHIP: SECTION: <br /> ALCIord 27 'A: S€ '/ A: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 1-7o ( ,Sl ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION fi = STAFF REVIEli , <br /> PROJECT DESCRIPTION: <br /> No Crr, n t 4ca� _s;b ___64.-6 . <br /> ❑ ZoningDistrict <br /> . This project is a new building or structure. <br /> U `Pernntted Uses' <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address r <br /> ❑SEWER NO SEPTIC (O w/e1IS tr S <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ W4tland/F1Q4d0r <br /> AREA TO NEAREST SQUARE FOOT: <br /> Sf oreland (attac lment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ECOSIO,10., l tQl ermfte <br /> ,, TOTAL SQUARE FOOTAGE: (slopes Ldisturbance, ";emu, <br /> 2ND FLOOR: flllin /aoc sS <br /> 3RD FLOOR: g <br /> © Review Location Survey` <br /> ESTIMATED CONSTRUCTION COST: $ `? C. and available9optfons ` ' <br /> (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 ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ®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? ca 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 No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► —* —■ <br />