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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> o�J O ✓ d1� ❑ Zoning Status;CUP; <br /> OWNqFR A ESS (Number,Street,City,State,Zip) ,� , Deed Restriction; CSM <br /> //0 0. L L K��a � gel Variance(# ) <br /> HOME PHONE CELL PHONE E-M IILADDRE S // <br /> , 01?"-2 ; 227_ c- SC�t f t/ -'/it c 14f/eSTCa"' ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRA TORN E <br /> #r// Salty set'{//(E.A. ❑ Site Plan including location <br /> AGENT ADDRESS CONTRAiET ADDRESS ✓/ of well/septic <br /> / <br /> (City,State,Zip) (City S te,Zip) ❑ Setbacks <br /> /sat/ III- 537/3 <br /> PHONE P ONE ❑ Site Plan approval from <br /> MDf— -2 <br /> ,3- 1/V69� applicable township. <br /> E-MAIL ADDRESS E- AILr DDRESS @ / . Or, ❑ Floor plans to scale- <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 1/4: '/a'/a: ❑ Driveway permits <br /> •ADDRESS: (state,county,town) <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION ;STAFF REVIEW <br /> PROJECT DESCRIPTION: 1/ L PAN eLs S ot,t✓ eu fr%� aritilY 4rawtd rrtor�7>I ❑ Zoning District <br /> . project is a new building or structure. ❑ Permitted Use's <br /> XThis <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ litural Address ; <br /> ❑SEWER ❑SEPTIC (rn"ew/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> •❑ Wetland/Floadplain/ <br /> Shoreland'(attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ❑ ErOSIOnCORtrol emit <br /> BASEMENT 1ST FLOOR: (slopes di 2tl ba <br /> el TOTAL SQUARE FOOTAGE: ,` fillig/access <br /> 2ND FLOOR: 3RD FLOOR: ,; <br /> ❑ Review Locatfo(�Strvej <br /> ESTIMATED CONSTRUCTION COST: and ava>labke api~lons <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ --► ♦ $ Sisk <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? ❑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 /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />