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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 /> Andrew S. ZQ rd aches 04 <br /> ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,CV,State,Zip) Deed Restriction; CSM <br /> 3 42-5 Meadow Rc,I•V 0u <br /> �ri h , WI. 53593 variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6018-338-3210 g+ee;guy @yct)tco•G <br /> ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> cam'. as Abeve, Sot tt as Above ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ■ ACREAGE: <br /> ❑nPAR ER o3$f0703-3ZI-16661 A ! • l ZS frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> M idd leIl n 3 Z. 1/; S tA/ %i: r'j ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 34115 M& dow Rd• wvcrrIa W I. 535'3 -952-2 <br /> ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> am iv., 1 (public,private) <br /> PROPOSED PROJECT INFORMATION y <br /> PROJECT DESCRIPTION: 11 �� <br /> 2 y x 27 Pole shed w( orate 1 Floor o zoo stirs <br /> . Ef This project is a new building or structure. D`Permitted Used' <br /> This project is an addition/alteration to an existing building or structure. { <br /> SANITARY SERVICE: PERMIT NUMBER: 0.Rural Addre s f <br /> EWER [EPTIC (new/exsting) <br /> HEIGHT IN FEET: 9, NUMBER OF STORIES: (Not including basement) <br /> D. Aletland/Fioodpiainl <br /> AREA TO NEAREST SQUARE FOOT: $110relaCt l tttaChrrient) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: D ErosionControi permit <br /> 4, TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 648 • <br /> D Review Location Survey <br /> ESTIMATED(Please round CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ 14160 • w and available options. <br /> lease round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [Ylo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 1211lo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ✓gYes [ o <br /> ❑ <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes 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) Lives �lo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes \lo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► <br />