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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE. <br /> OWNER NAME <br /> ie/ 647-ES Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) //�\ Deed Restriction; CSM <br /> Z. 7&3 I/rAfg,tL N KU So/ P,�i,g , 11JI ,�3S92 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADD ESS <br /> O. g_5'&Le ((QI, olog 7 I•• f t5 /a34/e- ahpp, air) ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> c /4 M� th +y't(;�m Pl'l 1rt+cil�, ❑ Site Plan including location <br /> AGENT ADDRESS CONTRA TOR ADDRESS of well/septic <br /> (City,State,Zip) (City,Stat ,Zip) ❑ Setbacks <br /> PHONE Plaerot= n ❑ Site Plan approval from <br /> `k(Li )-•Q1--10 7'7 applicable township. <br /> E-MAILADDRESS E-MAILA DRESS <br /> ri\ci(ntrectryl yr3,I5e ov,cUY ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION_(http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: URRENTZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL 0/ 109//--,;20.7-8b0-�1 ' I J1_ / �/ frontage drawn to scale. <br /> NUMBER oC /j <br /> TOWNSHIP: SECTION: <br /> WN OF-8 r s7rOL (Oq) a3 1/4: MA) 141%: /l/ ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> .2793 v'U6� 2't/ 'b a N/0 /.g/t> L 53 0 <br /> Li Sanitary permits <br /> CSM: LOT � / SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION ;STAFF REVIEW g <br /> PROJECT DESCRIPTION: _roan ^ / e I ICY X'O C c 1 jn v 4 x <br /> [.� C �/co YK3 C�� Zoning District �� <br /> This project is a new building or structure. k,„ Permitted Use? fd fJ 'JL <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: "Rural Ad• t <br /> ❑SEWER SEPTIC (ne • �` <br /> HEIGHT FEES NUMBER OF STORIES: (Not including basement) � �� <br /> 9 c` �wetlaridik66.6jW <br /> AREA TO NEAREST SQUARE FOOT: Shoreltd altgftfieti( <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> fESlioaCceonbae m <br /> t E T 4ron o r <br /> BASEMENT: 1ST FLOOR: <br /> 14 <br /> 4, TOTAL SQUARE FOOTAGE: 4, ( esdrb <br /> 2ND FLOOR: 3RD FLOOR: ",,,,,-:74v:;„5,V g. <br /> Review location Survey <br /> . <br /> ESTIMATED CONSTRUCTION COST: and available options • <br /> (Please round to nearest dollar) ♦ ■ --► ♦ ♦ --► $ LO <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes to ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the pro erty? ❑Yes 1:a No ❑Don't know <br /> 3. Have you talked with the township about your prof ct and are they in agreement? 0Yes ❑No <br /> 4. Has there been a zoning permit issued for this pro erty in the past 5 years? 'Yes ❑No <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) CI Yes 21No F.3 Don't know <br /> 7. Is this to correct a violation? ❑Yes lallo <br /> I APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► ■ —► <br /> 545-112(4/08) <br />