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- ZONING PERMIT APPLICATION .countyofdane.com SUPPLEMENT to Web-App# <br /> • PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNpNAME <br /> d- �A1r' ``_� <br /> levt Sf r-►'l ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 7138 4 e_e e k- Ave_ S ate . (mil) y 5-3 S$9 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILA I DRESS <br /> •O?' *13-300 i66g_ 12-2SO5 • • 0 Sh3Y-Cit 1 kau.GOW( ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRA'TOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRA'TOR ADDRESS of well/septic <br /> (City,State,Zip) (City,Stat:,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAIL AI DRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://acc:essdane.co.dane.wi.us/) CI Elevation of property <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: <br /> ❑ NUMBER O%/06//1 S'33J- g/j-f 4.3 g heS frontage drawn to scale. <br /> TOW SHIP: SECTION <br /> 1 1 ❑ Driveway permits <br /> I��5 3r' ►1�S (o /a: S E /a/a: NE (state,county,town) <br /> ADDRESS: b I 1 � _ q <br /> Z3� Cent, er 4Ue ) S U G YM (.� r 5 3�� / ❑ Sanitary permits <br /> CSM: LOT l SUBDIVIS ON BLOCK/LOT <br /> dgSSZ / (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW tl <br /> PROJECT DESCRIPTION: <br /> -S-1--arit-le Ske,As (2) / 30x A• ,q-ncI / /Ox/ ❑ Zoning District <br /> . 9This project is a new building or structure. ❑.Permitted Use?; <br /> ❑This project is an addition/alteration to an existin'I building or structure. <br /> SANITARY SERVICE: PERMIT UMBER: ❑ Rural Address Y <br /> ❑SEWER Li SEPTIC new/existing) -,= <br /> ' <br /> HEIGHT IN FEET: NUMBER•F STORIES: (Not including basement) a ` <br /> /2/ g i / ❑ Wet1andlFloodplain/ <br /> / AREA TO NEAREST SQUA•E FOOT: Shorelartd (att chment) <br /> (Outside dimensions including unfinished area, attached ga ages and above grade decks or porches) <br /> ❑ Erostonconirclt perrptt <br /> BASEMENT: 1ST FLOOR: <br /> ce/Zoo !L U lopesdstulr, i <br /> filling/aceess)a <br /> 2ND FLOOR: 3RD FLOC) : <br /> /ZOO//410 Q Review Location Survey ; <br /> ESTIMATED CONSTRUCTION COST: and availableoptions <br /> (Please round to nearest dollar) • ♦ ♦ '♦ ♦ $/SI ow/2 &U©=/7 o(30 9� 3 <br /> , - IL-(© 4coo --tom Foe_ <br /> 1. The property is within 300 feet of a stream or 1001 feet from a pond or lake? ❑Yes ;a No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the pro•-rty? jsi,Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your prof:Ct and are they in agreement? A Yes .0 No <br /> 4. Has there been a zoning permit issued for this pro'erty in the past 5 years? ❑Yes tgiNo <br /> 5. Is this project associated with a rezone/CUP/varia ce(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ONo El Don't know <br /> 7. Is this to correct a violation? ❑Yes Igi No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) - -* <br /> 545-112(4/08) <br />