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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> OPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ROSS -ro vi h ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 5/ 3 - j b 4W LitI . e.o i..-d. , /111A-r-s k p1Q.1 N31-., 5-3 s-S y Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 64-651--11/6S- 60e22.O 9044 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> 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 /> ❑ P RCER O3608f.t-a6y- 8500-0 4—I (Ex iiV.•- frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> al CA i rt a, Y4: 141/4: <br /> ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 57 3w Tow-1 c.'fkx- i( c)‘.(Q..(C/4 61 (1141°Lice'— 1 ctr i5 c"SS"v414 1) Wt l'')I1 ''❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> LhAn9t. Ott v3-c. af 01d fie, -b 1:1- • Ofte550,rci 6 vt"I diev)(ctyNw1h4,0 Zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: a2,6 K L ! z <br /> 1 ' `XLy ``c 1 ><IL' ! j TOTAL SQUARE FOOTAGE: ,,, (slopes,disturbance, <br /> 26 x. a,L! filling/access) <br /> 2ND FLOOR: 3RD FLOOR:' <br /> a ( X - Li/ _ ( o - Li Review Location Survey <br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ♦ --► ♦ and available options. <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 MI ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes &KO ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? a 'es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? O'Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/a.a.-= • ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes 0 No ❑Don't know <br /> 7. Is this to correct a violation? C Yes ❑No <br /> ■ l 2g, 0 0 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) - -0. <br /> 545-112(4/08) <br />