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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAAM <br /> JO ei-4/ 6 ' ' )2 Zoning Status; CUP; /4� L <br /> OWNER ADDRESS (Number,Street,City,State Zip) Deed Restriction; CSM <br /> �7 GUS L1/IOMS /�1�� Variance(# ) <br /> HOME PHONE "� CELL PHONE E-MAI RESS <br /> GI1,-F7 -VuCr 6 Lv�-? -4)x-3' a'/'/ s 07 z Lc 6z 1/1) yil, <br /> 0Site Plan drawn to scale A• <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions Ake. <br /> AGENT NAME CONTRACTOR NAME , �1 <br /> eleiv ifIL611,'b , ,i�b gSite Plan including location it/I) <br /> ADDRESS CO TRACTO ADD of well/septic <br /> (City,State,Zip) (City,State,zip) , , Setbacks 6 3/36/74 <br /> u &104/4 (,v, 65,511. <br /> PHONE PHONE %Site Plan approval from <br /> &or-,f'/. -:q 760 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ;I Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ►� Elevation of property �'l7' <br /> PARENT PARCEL NUMBER:2 CURRANT ZONI G: ACREAGE G �� p operty <br /> ❑NUMBER 0116/0�e01-og)-2So�i-3 141- t X' 3 77 frontage drawn to scale. <br /> TOWNSHIP: /�,, SECTION: <br /> /)I M cml S ,n165 ? %, S ci 1/41/4: Driveway permit:. <br /> state,county ow <br /> ADDRESS:7 P Z 60 tbalc /KI V <br /> CSM: LOT SUBDIVISION BLOCK/LOT unitary p- •"' <br /> �_ (public,. 1 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DE4CRIPTION / <br /> /6 x aZ 41 if/gill)) T Ni 46 g a/any ri. Zoning District ..- <br /> ❑Th' project is a new building or structure. "Permitted Use? A , <br /> his project is an addition/alteration to an existing building or structure. ', �€- <br /> SANITARY SERVICE: PERMIT NUMBER: Rural le1•Ol" . > <br /> FIEWER EPTIC (new -xistin' <br /> HEIGHT IN FEET: i NUMBER OF STORIES: (Not including basement)/ "" <br /> , " <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: c s� $ I roSIQnControl permit <br /> �/ 1 TOTAL SQUARE FOOTAGE: ,j, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 5 (t1-/ <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: /u ©© and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ ( I r o D V 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ge ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes to ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? 21 s ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Ear o <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 L❑rlo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes L 'J' `to <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ —+ <br /> 545-112(4/08) <br />