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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME U3 c <br /> tel0,A%�1 t w t SO A_ 4 A■ :i rk 4-- _ ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 43S-0 bCVMClCILS Tra+ C 4Cne.. �1 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ifA 4.1-" a.O1 Dz-90_ Long ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME N��T��R A CC T O R NAME '^ <br /> c ri ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRFSS ss Gl- of well/septic <br /> (City,State,Zip) (City,State,Zip) 0 Setbacks 50 0 <br /> -ram w <br /> PHONE PHON n Site Plan approval from <br /> 3�— 03 1 applicable 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 P/AARCE UMBER: (� CURRENT ZONING: ACRE E: /- p p y <br /> izi PARCEL NUMBER 0ti 0 ....0 3r0 �v ' r y(� to frontage drawn to scale. <br /> TOWNSHIP: 9 r ,�!!). ,�O rA SE 1 �+'�n_ / 1 1 A'r>j I Driveway permits <br /> ADDRESS: `� (Sanitary_s(state,county, _'� <br /> CSM: LOT UBDIVI ON BLOCK/LOT ' :' tS <br /> C—. (public �c�'` <br /> PROP OSED PROJECT INFORMATION STAFF REAL <br /> PROJECT DESCRIPTION: <br /> S�� - © <br /> .OA Y l=1 Zoning District, <br /> This project is a new building or structure. r i 1 Permitted Use <br /> This project is an addition/alteration to an existing building or structure. k''- e <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> Rural As s i 1 <br /> 0 SEWER ASEPTIC (neW lsting a k <br /> HEIGHT IN FEET /� NUMBER OF STORIES: (Not including basement) : a <br /> // ❑ Wetia landtvq tai m <br /> Shorefarjd (a�chm601 <br /> AREA TO NEAREST SQUARE FOOT: , -,,,„h,,. <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches)72 BASEMENT: 1 ST FLOOR: ) J EroSlovrtvdptro�f rM ti <br /> �1 j TOTAL SQUARE FOOTAGE: ,, lope's,distCurb°s fl e °� $ <br /> 2ND FLOOR: 3RD FLOOR: z ` 1 <br /> I' Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ,♦ ♦ ♦ -► ♦ ©© b ar davailableoptions <br /> (Please round to nearest dollar) I °` <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes lajklo U Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ro ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ..- res Li No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es 14ilo <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 to ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ti\lo <br /> 17 <br /> .51 OV APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -► -► -* <br />