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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 /> ji t'S Br61wtJ ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street.City,State,Zip) Deed Restriction;CSM <br /> 5 9 0S coun- y id C ✓ 4,1ad/rv,,+/ itwz 5370'' Variance(# ) <br /> HOME PHONE ELL PHONE E- IL ADDRESS '/ / <br /> . / Si 3-78'3 U)/!S'S/G1,/N-+; Ilitil it Co ®Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> OW i.'tr- ®Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE L Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> g Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 0-Elevation of property <br /> PARENT PARCEL NUMBER: CURRE TZONING: A REAGE: <br /> ❑PARCEL OW—O i tJ_��1r\ �C2 ,' �, O) ] frontage drawn to scale. <br /> NUMBER 6 0 I U Q °� <br /> TOWNSHIP: SECTION: <br /> 13V r`I'T€ '/a: '/a'/a: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 510 S C.ot)n+y 4.1 tots G✓ ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT F CRIPTION: p S�I / ^' g <br /> rA U 61 1(rlyl ❑ Zoning District <br /> . This project is a/new building or structure. <br /> ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Cl Rural Address <br /> FIEWER 1EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBEfj OF STORIES: (Not including basement) ❑ W <br /> k 1C1ver IP 14 , /S TI <br /> P I Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErOSiOnCQtltfOl permit <br /> BASEMENT: 1ST FLOOR: <br /> I a Go ,, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: `/`J filling/access) <br /> I a0o <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -�► ♦ ♦ Q� �J n �q/j available options. <br /> round to nearest dollar) �p ,l. (�(�(/ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes slo ['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? [ Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Jfres Dsio <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) Eyes Rio ❑Don't know <br /> 7. Is this to correct a violation? [Yes ao <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -to -. -► <br /> e45-112(4/08) <br />