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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App i <br /> PROPERTY OWNER INFORMATION CU -TOMER TO PROVIDE <br /> OWNER NAME / <br /> 1? uc 011\es-rone Zorling Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ����� De d Restriction; CSM <br /> .Q(DB Ntxi /8 So(�`t4i) rel3) UUi V lance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 5.13-y931 kid cat oD akoU•cow\ ❑ i e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION a d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> C\eart_ ( ,u■ldtvrs to Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS o well/septic <br /> iCIO Padlt Street <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> \IeTo1 , WI S3593 <br /> PHONE PHONE ❑ i�e Plan/pproval from <br /> h9(\- 8'-}5_Qic0 pplicat5letownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ' loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of ro <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: y P gPerty <br /> ElPARCEL frontage dr vdn to scale. <br /> PARCEL OttL{ I0,G6, "aoy-8845- c, A _1(- t - co i <br /> TOWNSHIP: SECTION: W <br /> Pe r f zC %: `f wiz*: ❑Driveway perrp+ts <br /> ADDRESS: (state, co ,town)4 <br /> Ua H,�y LOT SUBDIVISION• \ 1 • \\a-et) ,11pN I JBLOCK/LOT • .�89.i‘ry permits <br /> CSM: <br /> j 9 I (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ?aIe shed 0.7' X / ling District. Pi <br /> This project is a new building or structure. la Use? <br /> This project is an addition/ teration to an existing building or tr cture. <br /> SANITARY SERVICE: PERMIT NUMBER: ral Address <br /> EWER EPTIC �; ew/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: ('Ntbt including basement) <br /> '0' i <br /> Li��j`�1 <br /> ❑ Wetland/ (oodpl in/ <br /> vC 1 AREA TO NEAREST SQUARE FOOT: Shore) d (a chment) <br /> (Outside dimensions including unfinished area,attached gacages and above grade decks or porches) <br /> 9,42JC ❑ Erosion ntrol permit <br /> BASEMENT: 1ST FLOOR: <br /> 4, TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: eC filling/access) <br /> / _ ❑ Review Location Sury <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ y #, and available options. <br /> (Please round to nearest dollar) (000— 'S1 - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes Elo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies JNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? JC Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 'lo <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 "lo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/Oe) 1 1\, r (Continue on Back) -+ -i -►_...ki <br />