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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION A OWNER NAME + CUSTOMER TO PROVIDE <br /> D R SS Number, creel,City,State,Z' 0 Zoning Status; CUP; C— 2_ <br /> o R <br /> `� y >~ r. Pr 35 je Q Deed Restriction; CSM <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS Variance(# ) <br /> Zuy �qIV <br /> 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) 4 Setbacks ti L/,o/,0 <br /> PHONE PHONE Site Plan approval from N/6 <br /> applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL EL NUMBER: / CURRENTZONING: ACREAGE: Elevation of property <br /> LI NUM ER D�r i-323 - 254 S C — 2— it y 2_84 <br /> frontage drawn to scale. <br /> TOWNSHIP: py- SEC^T�ION: E ` � <br /> � (" tl 7 2 IA: IA IA: c E h'Drivewa •- its <br /> D <br /> ADDRESS: � L/ / /� 1 4 TT - (state OUnI ,town) <br /> CSM: ,� LOT / SUBDIVISION BLOCK/LOT kt Sanitary permits �///1_ <br /> (public,private) !'' �` <br /> PROPOSED PROJECT INFORMATION <br /> STAFF RE1 I§EW <br /> 3 <br /> Z-Q CTEJC IC1N or I Zonig D strict <br /> C <br /> . ❑This project is a new building or structure. i Permitted Use? b e <br /> W This project is an addition/alteration to an existing building or structure. / <br /> SANITARY SERVICE: PERMIT NUMBER: 1Z3{ l t,jra.A[{o g <br /> ❑SEWER ,SEPTIC l <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) vw—f <br /> 4.`! Wetlatiaki;adja m! 4 i <br /> AREA TO NEAREST SQUARE FOOT: `a'84. 6 (4441 M6*I M" <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: i ST FLOOR: p/� <br /> *Eitt-si6A'60-ittotejetiiif-'44,',:-p <br /> �0 V ,, TOTAL SQUARE FOOTAGE: 1 (SI 00:4 IiS EIPb Gek 4 <br /> 2ND FLOOR: . flilin 1 a t a <br /> 3RD FLOOR: ..(g© Al,- aG ess) <br /> Jf n <br /> Review L=ocation.i p /l <br /> ESTIMATED CONSTRUCTION COST: --► --► --► --► ♦ --► $ /ODD and available options JA <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 ❑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 ❑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 /> 545-112(4/08) (Continue on Back) —� -s. —� <br />