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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVID <br /> OWNER 1 <br /> rE <br /> ' Ch-v-& 0,--1)\ "a"k- >a\Yko,hn ird Zoning Status;CUP; <br /> OWNER DRESS (Nu r,Street,City,State,Zip) <br /> eed Restriction;CSM 3, <br /> Li 5 4-� l sa w� l-c\l tik variance(# <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 60 S 2 t1-°•SL ' Z Al Site Plan drawn to scale I <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimension <br /> AGENT NAME CONTRACTOR NAME 5(i <br /> 30041-C (ks a)g✓e- N Site Plan including locatio ((// <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Ef Setbacks 3 0/2-570 • c) <br /> PHONE PHONE •Ni. <br /> Site Plan approval from / <br /> applicable township. /r/ <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> AI Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT Pf.' MB URRENT ZO NG: ACREAGE �� <br /> ❑PARCEL � J � ����� / O/ a �� Elevation drof awn n to scale. <br /> NUMBER <br /> rontage drawn to scale. <br /> TOWNSHIP: t p SEcyp . /1/ <br /> ij GC.. ►' c-( d (� /J 1/,: /v £ '/a'/a: S IA/ 03 Driveway perm' <br /> ADDRESS: (state,county, lieSt <br /> ❑Sanitary •:.. <br /> CSM: (��(JX LOT SUBDIVISION BLOCK/LOT (publi <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: /f <br /> )c <br /> C fAX S ik� i"ark- <br /> ' / I / 2 is ` Zoning District <br /> . 12This project is a new building or structure. Ati Perm'ltt U e , <br /> ❑This project is an addition/alteration to an existing building or structure. ,, ,r, .1 <br /> SANITARY SERVICE: PERMIT NUMBER: J' oral ' "--" i� <br /> EWER MEPTIC (ne existin. <br /> HEIGHT IN FEET: 7 NUMBER OF STORIES: Not including basement) 4 <br /> etland/Flaodpialn/ <br /> AREA TO NEAREST SQUARE FOOT: Sh4lrelatld {attachment). i�' <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> l Ia,Erosionontro permit rmit /BASEMENT: 1ST FLOOR: Z Co C <br /> 4, TOTAL SQUARE FOOTAGE: 4, , 3i IStlb-disturbance <br /> , <br /> �filling/access , <br /> / <br /> 2ND FLOOR: 3RD FLOOR: 2 <br /> eYieW.L.ocation Survey:. <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ r� and available options. /I <br /> (Please round to nearest dollar) $ 5.0l/ •~ 4— <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies [ to ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? EYes r� o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes Kii o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yeslo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survei( :-\fED ❑Yes "lo ❑Don't know <br /> 7. Is this to correct a violation. ❑Yes a <br /> JAN 2 8 2016 APPLICATION MUST BE SIGNED <br /> 545-112(4/081 <br /> (Continue on Back) -► -► -► <br /> DANE COUNTY PLANNING&DEVELOPMENT <br />