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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 /> 1p�� (ZCjLSO.2 [Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 7593 St.LrPo L iZ Swt.fi('c ('i& t.4. S35-tiv Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ,33 OS-r'SK�. . - •l7Orlseite7v0/ b,'- "t e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> f 144.1 576 rL liKite Plan including location <br /> AGENT ADDRESS CONTRACTOR A DRESS il of well/septic <br /> (City,State,Zip) (City,State,Zip) 0/Setbacks <br /> Gre..57' tar 5135°3 2. <br /> PHONE PHONE l ❑Site Plan approval from <br /> 66$_ 6-25=7c 1'5- applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRFSS_1 <br /> 5 e,J —p L &;€; Lc,rt ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) dElevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING:' :.i ACREAGE: p p y <br /> ElPARCEL O Q` _ I / frontage drawn to scale. <br /> NUMBER O 6'—OT/i—)?-o5� P 1,L l r� 3j i r i <br /> TOWNSHIP: SECTION:/',L LOy3, ///��� <br /> Br, 5To 1 furcFNu) '/4: S .y ertva1/4-1/4: Q Driveway permits <br /> i ADDRESS: p (state,county,town) <br /> 75-9'3 .5uF o1K A 12_ Si iJ l ii'le. Wz S35-2, J Sanitary permits <br /> CSM: LOT i SU DIVISION BLOCK/LOT <br /> (public,private) <br /> tl I <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 1 10,4-11tei 4/t G V oning District <br /> . I This project is a new building or structure. lld'P/Zermitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Add eSs <br /> II----�� <br /> EWER IXpEPTIC (new xlStlntj) <br /> HEIGHT IN FEET: vv ++ NUMBER OF STORIES: (Not including basement) �� <br /> if / j r� ❑ Wetland/Floodplain/ <br /> / "° Lin+ bone Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1 ST FLOOR: ❑ ErosionControl permit <br /> j TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: c� <br /> q C4 f /.Z.. ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> —I.(Please round to nearest dollar) —, $ 2.5"--'000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Wes EINo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes alo (]Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? JVes Elo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Wes XIlo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#L 71(i; ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) QYes 'lo DDon't know <br /> 7. Is this to correct a violation? Eyes ao <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/1151 <br />