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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME �e'', J <br /> ���`!`J� �F ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 9656 70L---7-9 /5-.)0_ Variance Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADORES <br /> 'Oa -go- 0 ; oc`i '�Ec f-baC ('. (5-yi ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME., <br /> Ad L1 e? / '7 t'/',S l c C ❑Site Plan including location <br /> AGENT ADDRESS CONT CTOR ADDRE of well/septic <br /> /&max .Y51o / <br /> (City,State,Zip) (City,State,Zip) El Setbacks <br /> /2 c/scw 531IN <br /> PHONE PHONE ❑Site Plan approval from <br /> &0e 3 3 -605 5 applicable township. <br /> E-MAIL ADDRESS E-MAIL,ADDRE5S <br /> 11 LP' 4'06 s s ❑ 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 /> ❑NUMBER D 779g CPO S 1049 4^ %O frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> ` <br /> /ieD/.. J 7\j 1/a: '/4'/a; ❑ Driveway permits <br /> ADDRESS (state, county,town) <br /> I/6 Sb /c' ' t✓ M ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 9 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ADD//7&?V/ Zoning District <br /> . ❑This project is a new building or structure. !/ Permitted Use'? <br /> phis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: y J PERMIT NUMBER: ❑ Rural Address <br /> Y r7 `WER \ am-I OPTIC (new 412i51, <br /> HEIGHT IN FEET: yy �� NUMBER OF STORIES: (Not including basement) <br /> Z i . 1 Z Er Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) rOSiOnCOntrOj permit <br /> BASEMENT /� 1ST FLOOR: 1/ <br /> 0��,/_ !7 CZ/ ! a j TOTAL SQUARE FOOTAGE: 1 (slopes,disturbance, <br /> `3(f r filling/access) <br /> 2ND LO , / 2 �, <br /> z b 0 Sal` /1J° '27-5------ " 233 Lf. WReview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ G�� �,� 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 dNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ,No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ZYes ❑No <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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ENO <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4 ♦ -► <br /> 545-112(4/08) <br />