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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 /> j o!,_ SC# 1, z ❑ Zoning Sta ,CUP; <br /> OWNER ADDRESS (Number,Street,City,Atate,Zip) D ed triction; CSM <br /> 375-? M -elljr 1a Pe F0e-eS1, 1-,%.T. S 3 5 3� al.' ce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> b08- .6'y6 -77./ 6O B 4,Lt 5--71 3'-) Cg-'.--e- e rc°S-rr'' C67''''''- , 6"---"- Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ie Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS Df well/septic <br /> (City,State,Zip) Nr4N, (City,State,Zip) 12 Setbacks <br /> PHONE PHONE ❑ ite Pla pproval from <br /> appli le 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: p P y <br /> ❑ PARCEL / pp ...15-1_s)/ /� frontage drawn to scale. <br /> NUMBER (�6(-)/ I(� �d"Q /'"1 —, �Y /0 <br /> TOWNSHIP: SECTION: [ <br /> LA11.,(150 /5 1/a: N f% 1/414: NC <br /> ❑ Driveway rmits <br /> ADDRESS: (state ounty,town) <br /> 3 -75'7 ,, 4/,r> Pe For-495f, c,<,7- -535- v <br /> CSM: LOT ! SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> /` ' X 0 t-t91- 1- (p9b lc,.private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: AFF REVIIEW <br /> 1Wn lv, �"v � A (� � ® z- IRg C�IStrtCt � � �� <br /> This project is a new building or structure. <br /> V <br /> ' ermitted Use? <br /> ❑This project is an additi n/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: U Rural ° ®" sS ; <br /> n /exiStin �. <br /> ❑SEWER SEPTIC ( � }�) g . �� <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ' <br /> ll ❑ Pi m 0 his, ® ��ll <br /> Shorela;. (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: Ef'oSlOnContrcler1'tlt 1 <br /> / d6'A 9 j TOTAL SQUARE FOOTAGE: (slope isturbance,� <br /> 2ND FLOOR: 3RD FLOOR: fllling/aC-esS) ,� , <br /> -y � , <br /> ESTIMATED CONSTRUCTION COST: ❑ RevteW Locatiolitpooy' d <br /> (Please round to nearest dollar) "� '� ♦ '♦ '� "♦ $ t. s-00'%--- and available o bons �J <br /> f - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes UNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yeso ❑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? E Yes ❑N <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank none) <br /> 6. Is a location survey required? (see reverse) ❑Yes o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED 4 t(7) '- "7 .---- <br /> (Continue on Back) —► —► —0•545-112(4/08) <br />