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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME fi ail �.I o° (,-- <br /> OWNER ADDRES�Number Str t,City,State,Zip) `- Zoning Status; CUP; <br /> y // id. oz- 53 53 1 Deed Restriction; CSM [ �' J <br /> 35 2- ) 5 rAc� ��r� Variance(# ) <br /> HOME PHONE 1 CELL PHONE E- AIL ADDRESS // <br /> kg-74 -/317 kg -23A'?gg0 4,-,A Cr�� ii �'/�"Ait?✓', ' " pSite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimension /9 1eC <br /> A -'1"4AME r�..- 'y CONTRACTOR NAME <br /> N - 4 ► 00 Site Plan including locati 1 <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic / 0//°/.56 <br /> (City,stta�tFe,Zipr t 83 (City,State,Zip) Setbacks 3 O/ , <br /> 4,^ PHONE PHONE Site Plan approval from ii/A <br /> applicable township. <br /> E-MAIL ADDRESS -. , E-MAIL ADDRESS <br /> ,-, al Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) I b <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE Elevation of property /y! <br /> ❑PARCEL p7/2-agli-ga3S- a- R—I I o8 , frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Deer rl e)) TO 74/fj�/? a-g 1/4: /YE 1/41/4: S i/1 Driveway perm) <br /> ADDRESS: (state, county, oW ) <br /> a-1 S/01 e/'✓°,ce 0 S permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 06377 i private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION. � y 1C � / Ds � ` <br /> Qb f,t S. Leraye s f ru-c fu re - oning • / <br /> . E This project is a new building or structure. Permitted Use? (/ i <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER. 41 Rural yU <br /> EWER TIC (ne Xd Stin <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> A r,°.-r 1 > /etland/Floodplain/ <br /> `7 AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> Ei-osionControl permit <br /> BASEMENT. 1ST FLOG : <br /> 1 �,� �i a L t j TOTAL SQUARE FOOTAGE: 4, (Slopes,disturbance, a / <br /> 2ND FLOOR: 3RD/FLOOR:/` filling/access) / <br /> a g g 66 Ff <br /> y.4 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -I. -+ -+ ♦ -I. -. 'tdD dO 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 60 ❑Don't know <br /> ❑ <br /> 2. Is there a wetland or floodplain on or near the property? Yes ffiNio ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? :Yes E f o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes DKlo <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) Dyes Oko ElDon't know <br /> 7. Is this to correct a violation? 2 es ENO <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► -► <br /> 545-112(4/08) <br />