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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 /> Var I V Dahl G-h I Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,yCiitty,State,Zip) G y�t'/� ‘Al ed Restriction; CSM <br /> HOME <br /> 3603 7 E ar I w v PHONE d. ,-M+fogjR,1i o Y c,, A v I 5 3 52 7 Variance(# ) <br /> l: 76,y — • 7I (p0S 345 b7. dah a - I ZOV) , f et g Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> /4'Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State Zip) j 70 f �0 <br /> ( y. p) (City,State,Zip) Setback <br /> PHONE PHONE Site Plan approval fro <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> P i Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: C CURRENT ZONING: ACREAG : P P y <br /> NUMBER 0 I8/O7I I-262'85 00--to A- I (F.X 7V f � frontage drawn to scale. <br /> TOWNSHIP: SECTIO 1 1 1 J�/ IA/ Driveway permi <br /> C1o+-"a9 e, Carov'C_ "2 70 /4: I /a/a: i (state,county ow <br /> ADDRESS: rr�LL <br /> c3(e37 Earl w Loll- SUBDIVISION n I d • W I fckGG 0 d ('1 r0V.: I 535)7 Sanitary •ts PO ` •b <br /> (publi !vat <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ,,�•24 X Z(�` Bohu S ''' Zo ning District ' 771 <br /> Tear Do(.,h /Re,plc_ce, w I th BasernerytJ the i <br /> ❑This project is a new building or structure. h 1 D <br /> P 1 9 Permitted Uses <br /> This project is an addition/alteration to an existing building or structure. ie <br /> SANITARY SERVICE: PERMIT NUMBER: Ural ' "-r{'i° <br /> ❑SEWER /SEPTIC '(o.,, Otto" <br /> HEIGHT IN FEET: / j/ NUMBER OF STORIES: (N tt including basement) <br /> i7 <br /> AREA TO NEAREST SQUARE FOOT: Q� 'aREat �t1eAt) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: j � /� <br /> TOTAL SQUARE FOOTAGE: s• es,d' ". !:11''''' / <br /> a (j 00 <br /> 2ND FLOOR: 3RD FLOOR: /� f. �r� <br /> ESTIMATED CONSTRUCTION COST: v0ievlelnrOG>3tSur3/el <br /> (Please round to nearest dollar) '� ��� andBODDS <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'? TYes Li No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 'Flo <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) ❑Yeso ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ♦ ♦ -� <br />