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. / , <br /> 'ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME / <br /> D��� J C(,1 t( FFD Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction• CSM <br /> 3 4 13 ,1/5"4g v 4#9.-P✓/" cfit-A4,ei /d' V/ , S-3 5-5-Y Variance(# 3'701 ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRES� <br /> 77,3 — /I t— 21 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> D4Ill SC /'114 z 411-6/-/ aSite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> g2s'1-{may e4-, <br /> (City,State,Zip) (City,State,Zip) .121 Setbacks <br /> 60. 1 E,e,q-/zi -vca, Gt! / 535—5-`11 <br /> PHONE PHONE ❑ Site Ian approval from <br /> h o g-62- 3 -1-(C7 appkca a township. <br /> E-MAILADDRESS I/ E-MAIL ADDRESS <br /> G[O S.� <br /> e 6ill hd e Very 61 , /t/ .-7L*' la 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 0 Z Y/® _..6a0 Pi -c/ frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 6 Gti n '/a: 1/a'/a: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 3 y y 3 , Ism o 44- "ieet:4(244-A/4 to/ . s3 5. --ri <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ (public,private) <br /> / (public,private) <br /> ( PROPOSED PROJECT INFORMATION <br /> '.STAFF„RE741EW, <br /> PROJECT DESCRIPTION: i <br /> 24(S froa2 c e_ —c_. o . ! `� E.'tE nJT TU be-A4•.Z ❑ Zoning District , <br /> . ❑This project is a new building or structure. ? <br /> X j ` ❑ Permitted Use <br /> phis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Li Rual Adres r <br /> ' r <br /> 56NER ❑SEPTIC (new existing s <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> C — t N' LASE. &,� U'1 letlartdf/Floodpai r/ <br /> Shorelarjd (attachment) a <br /> AREA TO NEAREST SQUARE FOOT: r <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ❑ Erasionontrol perr>(ti <br /> BASEMENT: 1ST FLOOR: ,, TOTAL SQUARE FOOTAGE: j (slopes,dsu^ ane <br /> filling/ac':.,4,,:6-,04,-n5.--,:.-.-4 ess) <br /> 2ND FLOOR: 3RD FLOOR: � <br /> ZZ� I <br /> Review l ocation ati*g' <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ ° °p and availableoptions <br /> (Please round to nearest dollar) ‘, . , _, ,,, <br /> i-&P., r—E _ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? %34(es ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Jato ❑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 jago <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# 3r7 9'1 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) TSYes ❑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 />