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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> (Y\Pr� t N.A. �� <br /> dWNER ADORES (Number, reef,City,state, Zoning Status; CUP; <br /> 3.--- -g%-- t v S� ,_ C.3 VaDeed riance Restriction; CSM ) <br /> V�—J) Variance # <br /> DOME PHONE CELL PHONE ,JMAILADDRESS <br /> srhS-- 73 71?---7('‘i Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME _ <br /> Sk As rte )dSit- - - • luding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS o ell/septic <br /> (City,State,Zip) (City,State,Zip) <br /> Setbacks 3//3V/0/$ 0 <br /> PHONE PHONE Site Plan approval from/� <br /> applicable township. /v <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> kJ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> ❑ PARENT PAR ,EL NUMBER: ...6G6/...A <br /> CURRENT/�ONING• ACREAGE: I`. Elevation of property <br /> NUMBER d99i� —0 K , fjJq frontage drawn to scale. <br /> TOWNSH SECTION. r <br /> O� 1/a: !� 1/a1/a: Sr.. Driveway permits <br /> (state,coun 'o ) <br /> CSM: �J-1y i--r/`/LOT `G•iJ SUBDIVISION BLOCK/LOT <br /> �`�-Sanitary •- • its <br /> �O� (publi <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW_ <br /> i O PROJECT DESCRIPTION: ■ / % <br /> 0 1 Z Zoning District <br /> . This project is - en build• 6 or structure. <br /> This project is an addition/alteration to an existing building or structure. <br /> ,ermltte e� <br /> SANITARY SERVICE: PERMIT NUMBER: ' Rural " <br /> ❑SEWER Sew Isla a) _ <br /> \EPTIC (n g, <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 4 .�►eA'.odpiain/ <br /> horelartd t chment) <br /> AREA TO NEAREST SQUARE FOOT: , <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> }k- Erosion Controtperrni <br /> BASEMENT: 1ST FLOOR: Li Li m <br /> 4, TOTAL SQUARE FOOTAGE: (sIOp,4e�Sy t'�4�CIC�n44 v ,f fi <br /> 4/t filling/access) <br /> 2ND FLOOR: 3RD FLOOR: > nor <br /> ►'� Review l_oc,....Sure ' <br /> ESTIMATED CONSTRUCTION COST: d ' y� and available options <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ ✓ �1 V� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? CI Yes @efo ❑Don't know / <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes f /No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? DYes ❑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 />