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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 /> OWNER ADDRESS (Number,Street,City,State,Zip) � � �f u/ ✓�5 Zoning Status;CUP; <br /> Deed Restriction;CSM <br /> 2429' 7`yl,6e kor n .e Ve v0 . 4/2 <.?3f /ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADD- SS ,' <br /> ip ' AO 0 Pc-5 ?g eeC4 e ' @ -#ytq//' 7Ohh-‘ 4Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACT OR INFORMATION Arid includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> , Ci c, 6 q h 9Q V.5 0,rb.% C/eif ry 04/©�J, 6)r�, Ste Plan including location <br /> AGENT AD RESS CONTRACTOR'ADDRESS f well/septic <br /> P.o,P3O 930 oZ.3-0 P,a,13oyc 910 a a61 <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> Pr7ONE G, 7 PHONE ❑�S4tte Plan ap{I`roval from <br /> —YY_ -�'/ 7°° & - f ,1---9,200 7 applicable township. <br /> E-MAIL ADDRESS G,�'1 E ILA DRESS / <br /> /fCte hDevSb, / Off' . /e a - 4j/; �� 0 F oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://acces.,dane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURB T ZONING: ACREAGE: ®Elevation of property <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER luW O( (/4000-9 '� ya �, <br /> TOWNSHIP: SEC N: w <br /> (� �p IIQ -°, : ,/4,/4. , ❑Driveway-permits <br /> ADDRESS: (state(County,town) <br /> CSM: /'i/ r� LOT !.--f SUBDIVISION BLOCK/LOT ❑Sanitarypermits <br /> �b ,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: T- q �^ <br /> Po/e 13a v r-, — �:i Li I pvVl pvi vii-.5--r.. vq e_ S O I@ Zoning District <br /> . EIThis project is a new building or structure. / 'Permitted Use? <br /> This project is an addition/ eration to an existing building or struct re. <br /> SANITARY SERVICE: PERMIT NUMBER: } ❑ RUraIA EWER EPTIC (new/ isting� <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not ind ing b ment) <br /> / <br /> z // / LSJ;Wetland/Floodplain/ <br /> � /� Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: / <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) i <br /> BASEMENT 1ST FLOOR: ErosionControl permit <br /> " 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> �Y filling/access) <br /> 2ND FLOOR: 3RD FLOOR: //�� <br /> �V at <br /> °Z L Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ �0�, ao and available options. 1 ; <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? es ❑NO ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Yes EINo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYeslo <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 to EDon't know <br /> 7. Is this to correct a violation? DYes JZINo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> --"Y‘ CD ' O (Continue on Back) -► -► <br />