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ZONING PERMIT APPLICATION www.countyotdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> - <br /> r r L-t / D U k1, Zoning Status; CUP; —b <br /> OWN R ADDRESS (Numb Street,City,state, gyp) �- Deed Restriction; CS <br /> .33 70 (,l` k e 1< --S' n_ Pk-co r,E./ CIS- 5359 U Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> I <br /> ‘Ct S-3 7"6/51/ /QS--6 y:s--- L/2/ DE19b.,e ,.c...d73A w�Sw<<'V` Or Site Plan drawn to scale / =_)v <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> /-ic)G-„v•N LC or S e be rd Site P • ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of wel eptic <br /> (City,State,Zip) (City,State,Zip) :II Setbacks 6 ho7/"PiS,* <br /> PHONE PHONE iN Site Plan approval from/ / <br /> O',7'v1.- U - 62 9 2- s applicable townshi �V <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> AEI Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) (mot Elevation of property <br /> PARENT �PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y <br /> El PARCEL NUMBER �'�`�' b y3 z/ i`U !�/ frontage drawn to scale. <br /> TOWNSHIP: SECTION: • <br /> 106:-/VI C bur ke J� `/ 1%: S( `J 1�41�4. S I Driveway permits_ <br /> ADDRESS: (state,county aw <br /> X37- 13� fri�e ? � � � <br /> I- Sanitary permits H r <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,'-) Vf' /, <br /> PROPOSED PROJECT INFORMATION ,STAFF REVIEW A ��► <br /> PRI T DESCq IPTI <br /> p el 66,,t- 1,', ,r.. i „.1,D Z ,• r..--■ it ,Z;,b,hing District a <br /> 1 9 fj <br /> . ❑This project is a new building or structure. ►: ”"Permitted Used' r <br /> A This project is an addition/alteration to an existing building or structure. I1L : 'o <br /> SANITARY SERVICE: PERMIT NUMBER: 44!i1 RU ,° 4r <br /> ri <br /> D SEWER 17% SEPTIC (ne +o' a - ' <br /> HEIGHT IN FEET: y NUMBER OF STORIES: (Not including basement) €* <br /> . <br /> fhorelan. 'a ach e <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) g <br /> �roslorr�a' i�ral permlf <br /> BASEMENT: 1ST FLOOR: eld� ' ar , <br /> 4, TOTAL SQUARE FOOTAGE: j (Slope ;,lls,„ w, . <br /> 2ND FLOOR: 3RD FLOOR: ! , ✓ <br /> flllinglaccess <br /> /,LTJ � <br /> 4:1 Review Location Survey e_ <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ c�/� U�� and available options 4 <br /> (Please round to nearest dollar) �((, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 0 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 0 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 1.73 No CI Don't know <br /> 7. Is this to correct a violation? ❑Yes WI No <br /> APPLICATION(Continue on Back) ♦MUST BE SIGNED-t <br /> 545-112(4/08) <br /> -► <br />