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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 /> 7&� 3 E TA 1/6Sifi1CA(i 3 L C 0/Zoning Status; CUP;G (/ <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM /O 7 <br /> 2.7 Z CO rrr7 14`07, / J' 004.47O.;t.( Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> FAZIts_Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME, CONTRACTOR NAME_ <br /> SC.c 1�,/CCA((Tf S'> D PR-a -1--41.41.,.,alt ❑Site Plan including location <br /> AGENT ADDRESS ^ CONTRACTOR ADDRESS of well/septic <br /> 20Z f'602AOld-y (iOar7 D. 20 Z tLo2.4Vr4,.4 Voc«y 21..) S/!2//0 <br /> (City,State,Zip) (City,State,Zip) 0 Setbacks /� <br /> Kier)o (Adl c.)2 . 3,17- 1,C ,4-0,4Ag 1 c,))_ A 3 S w— it <br /> e Plana (oval from <br /> PHONE PHONE , pp <br /> 604, S o". $3 23 60F- $05. g--3 23 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> SeyAr♦. CCAR 2 - ( ,.4.. ( C�1{. ItCCR271-119 a Pau .JO Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Wiemation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE:El NUMBER 0146/06 i i -di I - x'330-1 C-Z j.0 ontage drawn to scale. <br /> TOWNSHIP: S Oil; S //`�/ <br /> c' -/� IA: S W �%: V ' F Drivewa ..l its <br /> DD �'gs,p,o/�T J�2�5--(G{s (state, • , town) <br /> ADDRESS: ,t <br /> Z 7 Z 3 C O 'T`/ H``'Y /l• `5r0U L.F(7o4 D. Sanita ry • ••'ts <br /> CSM: -- C 6 LOT `Z SUBDIVISION BLOCK/LOT <br /> (public, ��` <br /> PROPOSED PROJECT INFORMATION STAFF REVI <br /> PROJECT DESCRIPTION: a �, — Z <br /> S',q l- 6O .?C IZo Zoning District/ <br /> ���w i3,,�ca.�.t�, r( pV2 <br /> . ❑This project is a new building or structure. 1.— V "ac 3 4 s` Pi Permitted Use? I,VQ l i <br /> his project is an addition/alteration to an existing building or structure. a,[ <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> fo- Rural A•• - s ' y <br /> EWER nEPTIC (new - <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) (4 Wettatid#Reedpleiri/- <br /> i Shorela (attachment) 4 <br /> AREA TO NEAREST SQUARE FOOT: nd [OQ <br /> (Outside dimensions including unfinished area,a ched gara es and above grade decks or porches) .ErosionControl permit <br /> BASEMENT: 1ST ( <br /> '//'/ j TOTAL SQUARE FOOTAGE: j (slopes,disturbance- / <br /> filling/access) 70; , �/ <br /> 2ND FLOOR: 3RD FL R: <br /> Review Location Survey i <br /> ESTIMATED CONSTRUCTION COST: $ S0[1 0 ` C 0 and available options. <br /> (Please round to nearest dollar) ♦ ♦ -�► ♦ V <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No g Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o [abon't know <br /> Y <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yeslo <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) ❑Yes o ['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 />