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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME J <br /> RY'4n N / °E StmAl' ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction; CSM <br /> 5-0 9B Sul e1S,c- 2i DG,L 7 "d-/ c. Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (7(7 _L 2 -?°P) ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> . x-r ee i o e ?c -o ' fl .-Is- ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> o202.4 0 S Rte.ti le-G.-1 e J 4'/.J <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> M1 j0i --1-7, 1 S S02 <br /> PHONE PHONE ❑Site Plan approval from <br /> 6ot3 -.1 _`-)°f 7`7 applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> oc s0 ,€ex40-10,_Ae9„.0 rv/S. .�.n ❑ Floor plans to scale <br /> j <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZON G: ACREAGE: <br /> ElPARCEL 0 8O6301-Hwb-7 A- 2(2 .2 .2 A-c, frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 5P '/4: '/4'/4: ❑ Driveway permits <br /> et FI e LT--, (state, county,town) <br /> ADDRESS: <br /> 0 6 Su h is e-06 Y��'rr G ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION - STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> E_C,, A-0017-lo N. ❑ Zoning District <br /> . <br /> This project is a new building or structure. <br /> ❑ Permitted Use'? <br /> EThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER. ❑ Rural Address <br /> EWER r)EPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> (d ❑ Wetland/Floadplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shflreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ❑ ErosionControl permit <br /> j TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR. <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ v7� and available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies ENo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Dies ❑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(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Dies No ['Don't know <br /> 7. Is this to correct a violation? ❑Yes [c]No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -+ -► <br /> 545-112(4/08) <br />