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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 /> ` (. �- oning Status; CUP; <br /> OW ADDRESS (Number,Str ,State,Zip) " .. Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL NE E-MAIL ADDR S <br /> to Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGEN AM", ' % . CONT CT°-R NAME /' <br /> d/-��° 1 AJC ��JJC-/l e i iA/c Usiti Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 33/ r - c 57 <br /> (City,State,Zip) (City, Zip) ebacks <br /> V � ,/1t4-K GC/ <br /> PHONE PHON / ❑Site PI a oval from <br /> s�-D C C appl ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us!) tion of property <br /> �j PARENT PARCEL NUMBER: C ENT ONING: ACREAGE: P P y <br /> '='NUMBER 0 I�303-025/a-O �. (9T) ;62.lit;?:14?& frontage drawn to scale. <br /> TOWNSHIP: S CTION: <br /> ` / ,� e) S7O C Ntc) 'A: 5 '/4'/a: El Drive y p its <br /> V ADDR SS: (star nty,town) <br /> ) FW-N1'S b(p11✓F <br /> anitary peel is <br /> CSM: LOT SUBDIVISION BLO K/LOT w� <br /> T I_ ���-� ,,,�- (Public, • <br /> Co 8 r/S <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: 1 <br /> N•ef-ci 45- SF �.l G \ ui�!'Iooning District <br /> . his project is a new building or structure. \ lll4 rmitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: IM : I Address <br /> FTEWER PTIC 3 !s .,n c existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 3 a ) ' ,-S :7 "a_ ❑ Wet- - F =.dplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shore - (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: g 1ST FLOOR: g Erosion o •1 permit <br /> / 3 9` ,A68" 1 4, TOTAL SQUARE FOOTAGE: 4, (slopes •,Sturbance, <br /> 2ND FLOOR. 3RD FLOOR: f1111 S) <br /> I 8 \� 9 evlew Lo -tion Survey <br /> ESTIMATED CONSTRUCTION COST: ����0 4-- and available options. <br /> (Please round to nearest dollar) ♦ ♦ -0 --0 -•0. ♦ i <br /> \00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Ofc b ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Des ❑Ncr ❑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 J6' <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 [5on't know <br /> 7. Is this to correct a violation? ❑Yes E loo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />