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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME t _ /7 f <br /> F©V 0 L c ` ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ,5:$ 72, Deed Restriction; CSM <br /> ?Ds-e• COa-A(T/ AO4 P S "Cytl,, 10 to/ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> <01-02 7'— '35S s,�1 Y dw 0 G 4-/L - C ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> TDB( LL)1 -L C tlf ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ?0 5, Cece,(17)/ R0 -S <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> /1 "i Ile,It' k /, 5"35 72._ <br /> PHONE PHONE ❑Site Plan approval from <br /> CO F-,27?-4(355 applicable township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) E] Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER ZY0fl1.- c, t-¢39 So--7 !Q^l (0.3 <br /> TOWNSHIP: SECTION: <br /> S PRIA/G j'A-4E '/4: '/4'/a: ❑ Driveway permits <br /> ADDRESS: (state, county, town) <br /> T195.<6 C0(1/t7 b 404-0 $ /AT. f�Dfc� to/ ,5-33'72.- ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> P.E'T -T P 6-� (TLS ❑ Zoning District <br /> . EfThis project is a new building or structure. LI Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEWER r)EPTIC (11eW/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> /6 ' LI Wetland/Floodplain/;" <br /> AREA TO NEAREST SQUARE FOOT: Shorelarid (attachment) <br /> (Outside dimensions including unfinished area, attached garages a d above grade decks or porches) - <br /> . ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: , Zr�Cat7*� <br /> ,( c — 2 4-1 s'o'x 5D 1. TOTAL SQUARE FOOTAGE: 4, (slopes disturbance, <br /> y ✓ v JC filling/access) <br /> 2ND FLOOR: i �0p y4 3RD FLOOR: <br /> l _ X . 3)10 . ❑ Review.Location,Survey, <br /> ESTIMATED CONSTRUCTION COST: o and available Options." <br /> (Please round to nearest dollar) <br /> ZgZ.sa <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes gNo ElDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No 'j Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes KINo <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) gfres ❑No ❑Don't know <br /> 7. Is this to correct a violation? :Yes Eitio <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —* —* —► <br /> 545-112(4/08) <br />