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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> • <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NA t " G6)1 6 ...,e6&E1213L "V. ' 74. KZoning Status;CUP; <br /> OWNE ADDRESS (Nu ber,Street,City,State, ip�1 /f n <br /> I./k/ Deed Restriction; CSM <br /> ali� C/7ff Zr� l U�/�C V+�'U/� J`3J� Variance(# ) <br /> IjOhtf''PHONE CELL PHONE /D-e-) E-MAIL ADD SS <br /> 1= 44-G So 6i j <br /> , g- 'g-25So At-her t& c/lcrrfec vi Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRALTO NAME <br /> 0CJN, 066A/67e�/\ (14/Site Plan including location <br /> AGENT ADDRE S CONTRAC R ADDRESS of well/septic / <br /> (City,State,Zip) (City,State,Zip) Setbacks 7 / y <br /> PHONE PHONE tirSite Plan approval frorAi 4._ <br /> applicable township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> �!l Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT Z ING: ACREAGE: <br /> LI NUMBER 67//_ i ny -l 0/- i- 01- /. 3/ 3 frontage drawn to scale. <br /> TOWNSHIP: / SECTION: <br /> O 1%: Al. - /41%: /✓ Driveway per • <br /> /Q(AJA 4( 007-7-/9 v . / <br /> ADDRESS: (state,cou . own <br /> 21 L-5°u7' e,6'/ Or arr�G& ov Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, private) /� <br /> •PROPOSED PROJECT INFORMATION t STAFF REVIEW ��/ <br /> PROJECT DESCRIP ION: z <br /> 2-0 A( /Z X) Zaning District - �"• <br /> . This project is a new building or structure. Permitted Use? <br /> o an <br /> ` , <br /> • I ion/a � � 4e <br /> SANITARY SERVICE: PERMIT NUMBER: >�Rural ° - <br /> ❑SEWER SEPTIC (ne <br /> f ' <br /> HEIGHT IN FEET: / ^ / NUMBER OF STORIES: (Not including basement) <br /> L I a WetlandlFlo ocZ(a�n/ <br /> h !,, <br /> AREA TO NEAREST SQUARE FOOT: , <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porchev�,. ErosionControl permit <br /> BASEMENT: 1ST FLOOR: yn �� � <br /> Z / f✓ 4, TOTAL SQUARE FOOT•G.. , slopes;disturbance', ,r fi <br /> filting/ace <br /> 2ND FLOOR: 3RD FLOOR: �vd <br /> 1,i Review Locatromsurve <br /> ESTIMATED CONSTRUCTION COST: 7/ nd availab *1!•* s-4, v <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 ,esllvo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 121Vo ❑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 jallo <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) DYes DNo Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> AP (CATION MUST BE SIGNED <br /> 545-112(4/08) (((JJJ ((JJ C ti -*n Back) -► -► <br /> 0 0 joor <br /> l <br />