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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 /> - Y �EN/v ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 30.3-0 "HI DIjc V/62.0 L. ' Vel&WA� Wi S3593 Variance(# ) <br /> I4AMEP44 t E CELL PHONE E-1AILADDRESS <br /> ,of3•S9-7.106,53 c--1 s bens\mdz f1ncx 1• d m Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION wand includes dimensions <br /> AGENT NAME CONTRACTOR NAME ,{ <br /> e,LEN11-V 'ui�4IA-k S W Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS Si3 111 of well/septic <br /> Pox 930220' V , wi <br /> (City,State,Zip) (City,State,Zip) Xsetbacks <br /> V'E IV P■ GO 1 Sr-SS-9 9 3 <br /> PHONE PHONE } ❑Site Plan approval from <br /> (1208— 212 - 2/29 applicable township. On f7&eSS) <br /> E-MAILADDRESS E-MAILADDRESS <br /> OFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER' Q�//� L/ CURRENT ZONING: ACREAGE: <br /> ❑NUMBER <br /> OtC 0 8 0'}i�/- A- 2 ? 020 acres frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> /0101-) OF VEYzDN A R. ,. 1/4: SE 1/41/4: ❑ Driveway permits <br /> ADDRESS: <br /> p n (state,county, town) <br /> a -U o2 14)/4 ITC 04.0 SS r/l2EN Vege/VA! 1.01 34 3 <br /> CSM. LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION :_ STAFF Review <br /> PROJECT DESCRIPTION: ':,,,' <br /> NOgo t t )WC, AZ-6)\-)14 ❑t Zoning District n <br /> . XThis project is a new building or structure. r <br /> ❑-Permltte4UspVa , <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> 1)EWER r)EPTIC NA neVl/exiSting) <br /> HEIGHT IN FEET: i b NUMBER OF STORIES: (Not including basement) <br /> ❑ 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 /> ❑ EcosiQnContn3l ' <br /> Bf49!'1L11'Ei1'r:OJ7bCOf!- (10U2�P-[1 1ST FLOOR: l[NT£��Q1�L3 � �'��� �� <br /> 5—'/0 S c ?moos /4 loo o S TOTAL SQUARE FOOTAGE: (slopes,�disturbance, <br /> 2ND FLOOR: 3RD FLOOR: 11, (pY� filling/aCCass <br /> ESTIMATED CONSTRUCTION COST: /�q ❑ 'Review Location Survey; <br /> (Please round to nearest dollar) ♦ — ♦ '♦ ♦ ♦ $ o� 10n coo ' and available options. <br /> a i A.)rf3a`i rreru r?YES bt - gc,u� coxarn- M■, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es (Vo ]Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Iril es ❑No ❑Don't know <br /> 3. Have you talked with the township about your projeRE Elk/ErDe nest? 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(pNOV n/aopelltt ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Ekes NIVo EDon't know <br /> 7. Is this to correct a violation? [Yes NNo <br /> DANE COUNTY PLANNING&DEVELOPMENT <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► <br /> 545-112(4/08) <br />