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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 /> &i / 7 i G-1//- 4,e/E GLC ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 22-2 A/a,Z.7/f- sT7ce--e7 ,/t4o9-.O/Sow✓, wi 5 37a.V Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> D,g - S 77 W.gv 9t61 •-e/tC44, fm/4rs, .�' ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> / .VI_ vv,'lt- ''`' 741 - t' 7/ 4vie__,D. s ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 5/0 s✓,6PC-xiK7 y r Z 6 Z 5 / SEiolet,v ON-'e' 0,e <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> pUle-rl+- , r,✓t 5 37o/ 1/7ci v,---Gi A..// 557// <br /> PHONE PHONE ❑Site Plan approval from <br /> °8 -WC-716 9 6 OS -27/-07/7 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> k (e cl©wr/44.-f/C,MOei,sow . -r imltNa © /v -fill• o—g, ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑rrmcBEER 0 76 9 - /3Z- Z/u/ -9 71 �Z/is f�rs�oyfr, r y, r7 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> / . %. /a'/a. ❑ Driveway permits <br /> (state, county, town) <br /> ADDRESS: <br /> 3/d X45% i--c/�-s�/..,/G7'ew he U,Q <br /> ❑ <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> (public, private) <br /> Gii()ez-ec�e-- 3 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 6-79-4-4y /22_ 7/,41-54- // /J 4bte7.u0tiis / 5!/,a e',4..i c�4re fAQ/e(A/G ❑ Zoning District <br /> . ❑This project is a new building or structure. <br /> ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> 17kWER [EPTIC fi6P Ale- -z /6 —l /e o (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> N /� /a 3'_z ❑ Wetiand/Floodplain/ <br /> Shoreland (attachment) <br /> • AREA TO NEAREST SQUARE FOOT <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ❑ roS10rtCOntrOl permit <br /> BASEMENT 1ST FLOOR: <br /> ,l, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR. <br /> N7,f53 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -0. ♦ -I. ♦ -0. -•• 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? Elves No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Des ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? JYes ❑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 No ['Don't know <br /> 7. Is this to correct a violation? Des INN <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -0 -► <br /> 545-112(4/08) <br />