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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> • <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> c4b0 `- IA-0bLi ✓ da 1 e_41 ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zi <br /> n Deed Restriction; CSM <br /> S`I/�O L�f5 ;clog IJY - t ` /i 11, L Jr 5''i l 2 Variance(# ) <br /> HOME PHONE CELL HONE E-MAIL ADDRESS <br /> (Zi • S YYS$I CC1411-C - Y\C1-4 S '0 I.e, uti co 'CI"'` ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT <br /> Ipstiu4 NAME CO RACTOR NAMES "' <br /> Poko;' . I i�{YP; li ,.;1,66._ ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> C?() 11/ L1659-10 0 o 1 mac/ t6Ala ( ) <br /> (City,State,Zip) (City State,Zip) ❑ Setbacks <br /> M aCi ISLR , to )r CE 37yy ()loci 1 s61 +__u' cp3-71'�� <br /> PHONE PHONE r (, ❑Site Plan approval from <br /> LI L/Ci . .‘ 73 4iO" _(0 30 .Cj applicable township. <br /> E-MAIL ADDRESS <br /> E- AILADDR S �j' <br /> �G11}{ e_-��Ctr �(' ; .0 , rip' <br /> 11 ((0t� L /�U � �i 1'li 4- door plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evation of property <br /> PARENT PARCEL NUMBER: <br /> /y_ /� CURRENT ZONING: ACREAGE: <br /> ❑NUMBER 04/x1 'C�3 ':IC7,�7-d l ,�r 22_. fronta.- or Cale. <br /> TOWNSHIP: SECTION: 1 `, ri <br /> .; { ele:d ,/4. ,/4,/4. ❑ Driveway permits <br /> ADDRESS. ��, I (state,county, town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> Ill (public, private) <br /> , i� - <br /> PROPOSED PROJECT INFORMATION ; STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> KetA) C' ) utc. n1 CAS'Wing Diistrict <br /> . ]This project is a new building or structure. <br /> ,,,te�rr <br /> permitted Use? <br /> OThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ R- I Address. <br /> 'FEWER gri.EPTIC "3.)0/ - ♦a), ci x isting)' <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> g ` / 7+ Wetland/Floodplain/, <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) EroSi '' - ' : rol permit <br /> BASEMENT , FLOOR: (� <br /> Aga)9 _7 et ,► , tfc/35 4, TOTAL SQUARE 4 (S1ppeS <br /> ,dtstUrbance, <br /> 2ND FLOOR: 3RD FLOOR: fllling/acCeSS- <br /> 120c viA0 OP ' <br /> ❑ Review Location Survey S <br /> ESTIMATED CONSTRUCTION COST: ♦ --► ♦ ♦ ♦ ♦ 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? Elves ElNo ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? Elves ao ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ElYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes Do <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) Efres ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes [ No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -* -♦ <br /> 545-112(4/08) <br />