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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 /> OWNER ADDRe� N�mbe Street,ci ,star -e ( r«�& ❑Zoning Status; CUP; <br /> ZNE Va ancce(#fiction; CSM )HOME (� L PHONE CaQc E-M LADDRESS <br /> O — rF— ° '- z—Z2-OaSto4_ • 401 IA ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> (AY(itiaw► -Over-it is - --T--'-$ CO454YV C..\O11\ ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESg of well/septic <br /> 3`i cy IK�1 <br /> (City,State,Zip) (City,State,Zip J l ' , 6^(I ❑Setbacks <br /> PHONE <br /> _____EA E� W ti 'JS"I ❑Site Plan approval from <br /> 1,08- 21-- 9232 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Ts— CoA5A-_ CAM e Y4.cook ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER t 7 Q–p y-g3/s--3 g - A Z,18 <br /> TOWNSHIP: SECTION: <br /> /Q-16I O 12_ 1/a. '/a'/a: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 3 q c,.4^ �e Sanitary�� LOT 1 SUBDIVISION BLOCK/LOT ❑ ry permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTI N: <br /> eiad•' 6' ❑ Zoning District <br /> . ❑This project is a new building or structure. <br /> ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: LI Rural Address <br /> EWER PEPTIC . (new/existing) <br /> HEIGHT IN FEET: i u NUMBT R OF STORIES: (Not including basement) <br /> I ..---- ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 80- ❑ ErosionControl permit <br /> 13(,- I' OeCk Zi� ,, TOTAL SQUARE FOOTAGE: ,' (slopes,disturbance, <br /> �lJ t�G filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 2'132. ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ �,n/t . and available options. <br /> (Please round to nearest dollar) t� 036 <br /> 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Elves VI■o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? gives Vo <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# /687C)- <br /> 687 (leave blank if none) <br /> 6. Is a location survey required? (see reverse) [Yes ZI. o ['Don't know <br /> 7. Is this to correct a violation? Dies T4 o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />