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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAM '/ <br /> a r i( 4 I n eV` i 141 ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,Sfate,Zip) <br /> //0 W l h dl nc Q y KA I /(2`'O/.7 �1 535 2 Deed Restriction; CSM <br /> Variance(# <br /> ) <br /> HOME PHONE CELtPHONE <br /> E-MAIL ADDRESS <br /> '2b2 I-q2°Z .J-1'Pahzen:-%• deno.tde h Iders .GoM LI Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME i CONTRACTOR NAME <br /> 1- 'ar r -eQab/r arr L eiloQif 1!gU /dep5 .ric; ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 7923 ,9l rporT Rai, , a rn tv <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> i7),olc /floe, G3/ 53 S& Z sa hi r <br /> PHON PHONE ❑ Site Plan approval from <br /> �6660 $3 I_ c'q Z Z S a h,,, e applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> harT®dCncbkebu''(ders ,con, 54 m 10. ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dlane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> LIPAR frontage drawn to scale. <br /> NUMCEL FBER � O$�'3�2��dzy-� <br /> TOWNSHIP: SECTION: <br /> p is )1,1-6. <br /> l �-�i-e/d IA: '/a'/a: ❑ Driveway permits <br /> ADDRESS: (state, county, town) <br /> 7862 Tn,m ri Po h d `rr ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> brtji mn 'a <br /> (public, private) <br /> 'id <br /> ..... ........ . ................ ... .. .. .. .. . .. ... <br /> PROPOSED PROJECT INFORMATION ;:STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ❑ Zoning District; <br /> . This 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: ❑ 'Rural Address ' <br /> EWER IVEPTIC 13-2016- 0 Obi/7 (new/existing) . <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> X33 2 ❑ ,Wetland/Floodplain/. <br /> AREA TO NEAREST SQUARE FOOT: Shorelaftd (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 1� ❑ ErasionContro(permit <br /> 2 5/ 3 2-&-3—(090Z...5-- <br /> ` DZ5 1. TOTAL SQUARE FOOTAGE: 1 (slopes,disturbance, <br /> , (O fillinglaccessI 'I:= <br /> 2ND FLOOR: 3RD FLOOR: <br /> f,1 Y 2 7, 7 3 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: '" - 'and available options, <br /> (Please round to nearest dollar) -+ --* -+ " $♦ $ 6,4/0 00D <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? Des ( No ['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? 0Yes [XCNo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# xi 6 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) [Yes ENo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes KNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —* —► —+ <br /> 545-112(4ro8) <br />