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ZONINGRMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ■›-e" i"L."^otsk 0%4 y.41 tr" ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> /0 Aso Gd VW A- wy = Variance(# ) <br /> HOME PHONE CELL ONE E-MAIL ADDRESS <br /> V"( / <br /> ‘�—'a 1'P-DWI *moo' lie a r ri1 r".- - ' ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> � ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR OR AD RESS' �, of well/septic <br /> `p L ,41 e{(JG. IJel I-e. -NE(City,State,Zip) (City,State,Zip) Setbacks <br /> 5,,, er a i J C... L ' S--. 2)O <br /> PHONE PHONE ❑Site Plan approval from <br /> t oco -Z-- .-/5s6 tS applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ,,,,,ti .,,\ /1,c4� --_,4 h u;00/5.caM ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL R / frontage drawn to scale. <br /> NUMBER 0)O/D �ql ' �` 14 �' 3 7(� aGVt S <br /> TOWNSHIP: SECTION: <br /> To CAC" e h£ N0vKd S 1/4: 1/a1/: ❑Driveway permits <br /> (state, county,town) <br /> ADDRESS: <br /> /0%0 I GO-AA---) N""1 t ❑Sanitary permits <br /> CSM:U LOT SUBDIVISION BLOCK/LOT (public,private) <br /> I I <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 'QQ., k�c d Gcfc ❑ Zoning District <br /> . <br /> This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EER PTIC (new/existi <br /> W ng) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> f1. ❑ Wetland/Floodplan/ <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: ❑ ErosionControl permit <br /> 3 .j TOTAL SQUARE FOOTAGE: ,j, (slopes,disturbance, <br /> I 2ND FLOOR: 3RD FLOOR: filling/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: - and available options.•(Please round to nearest dollar) <br /> / <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Lives Nlo ❑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? N'Yes o <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# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Dies ( to ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► -► <br /> 545-112(4/08) <br />