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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 /> C I tvt/ Irk c/�U--- ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> acloe kk-er R 0 5� k, Deed Restriction; CSM <br /> x/ Variance(# ) <br /> HOME PHONE ELL PHONE E-MAIL ADDRESS <br /> 6-Cg ki.— I?98 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ 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 /> ❑PARCEL o stio9 3`�ayoo /q-/ EX i,a y frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> �u n �;r O S 1/a: s %oh: s r,.! ❑ Driveway permits <br /> ADDRESS: (state, county, town) <br /> 0?'a' Ahk•6c- (20 ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 2-?- rl 11 c�v�5 <br /> ❑ Zoning Dis#nct . <br /> . is project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: LI Rural Address , <br /> EWER PEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> t& r.--C ❑ Wetland/Floodplain/: . <br /> AREA TO NEAREST SQUARE FO Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ; <br /> BASEMENT: 1ST FLOOR: ❑ Erosioncontrol permit <br /> 6 y8 j TOTAL SQUARE FOOTAGE: + (slopes,disturbance,. <br /> 2ND FLOOR: 3RD FLOOR: �f fllltn /aCCeSS� ' <br /> ❑-Review Location,Survey <br /> ESTIMATED CONSTRUCTION COST: !� a available options. <br /> (Please round to nearest dollar) / 0 <br /> 8 nd <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des I 5 No ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes ao ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? []Yes ❑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) ❑Yeslo ODon't know <br /> 7. Is this to correct a violation? Efres ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -0 -0 -0 <br /> 545-112(4/08) <br />