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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # -
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<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> X IQ— 1 I.
<br /> Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM
<br /> °O �'c riiE Re,,cD Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 6°6- 1-'4'3-5512) 6°5- Zip- ,17(7. 6r e 1)1dKes4.ok-Ctpd.(.ar"",
<br /> o ►= 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) At Setbacks 11/11/14.0 4 0
<br /> PHONE PHONE gSite Plan approval from r
<br /> applicable township. /V
<br /> E-MAILADDRESS E-MAILADDRESS
<br /> �� Floor plans to scale / u //
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) I Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE:
<br /> D PARCEL 'R 2 - 65 frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: SECTION: Ai/A--
<br /> Toga a>r n,c t Apc-<t oN 1/a: 1/41/4; Driveway permits
<br /> ADDRESS: (state,county
<br /> 30DI. Rf�c1E gogD I UERc,NeN, �( 53593
<br /> Al Sanitary pe Ills
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public )
<br /> PROPOSED PROJECT INFORMATION STAFF REVItEIllf
<br /> PROJECT DESCRIPTION: ! ,
<br /> Srl DtaISrloP Zoning District.,.. ,„..,„:,,,,,,5, _,,,..,„Er 0:'
<br /> r.. ,„. ,.„ , ,
<br /> 1E6-his project is a new building or structure. Permitted Uses
<br /> ❑This project is an addition/alteration to an existing building or structure. c f
<br /> Rural `,
<br /> SANITARY SERVICE: Nc,10€ PERMIT NUMBER:
<br /> ❑SEWER ❑SEPTIC . - (ne ' ., N ,
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) I
<br /> M£A, = 12-i 1 `Wetland/Floo I 0 4
<br /> SFtoreland (a c hie *: '
<br /> AREA TO NEAREST SQUARE FOOT: '7 bo + Il
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ,
<br /> NCO SI0g4lttl{, P76r1 Ttti '..i.: A
<br /> BASEMENT: 1ST FIvOOR:
<br /> t$ 10 $ t-7 60 j TOTAL SQUARE FOOTAGE: ,, (Slopes,distUrb'ance,
<br /> 4o' if` fillingfaccess)N 4 A
<br /> 2ND FLOOR: 3RD FLOOR: O g
<br /> • Review ;,oeaa�n Srinre'
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ 2 aoo nd available option %
<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? 'Pa DYes EI 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'? Erles ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ENo
<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) ale's ❑No ❑Don't know
<br /> 7. Is this to correct a violation? DYes 8' l0
<br /> APPLICATION MUST BE SIGNED
<br /> / �I,n n O (Continue on Back) -► -p
<br /> 545-112(4/08)
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