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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #/6 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> AIR NAME <br /> � �� _. C� El Zoning Status;CUP; A ' / <br /> OWNER AD RESS ( � ,Street.City,Sty,zip) , .eed Restriction;CSM <br /> 01561- Hui T 1L PrN r i e. W i 53510 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL.DDRES$ <br /> 401S'$37" 4 Ar " '"3°'(Q • • S,_ ■- q If--r r NI Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions 4 rC <br /> AGENT NAME CONTRACTOR NAME AA <br /> Dt 4 \ Lin r- 1 Site Plan including locatio / 7 f <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic - <br /> (City,State,Zip) (City,State,zip) Setbacks )5/5/2-0//0 <br /> 1-otCor\ W 1 <br /> P <br /> PHONE PHONE 21 Site Plan approval from „/ <br /> applicable township. v <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> kC,�( <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) f/� <br /> PARENT PARCEL NUMBER: CURRENT NIN ' ACREAGE: I� I Elevation of property <br /> ❑PARCEL O�j/—z 7 / -9 00°-6 / frontage drawn to scale. <br /> NUMBER y- OOy�/-(( r <br /> 3 V \ �/ 0. f ) SEC,ZIO1 1/a: N WA: S Drivewa rmits <br /> v-j�/7- state, • <br /> ADDRESS: , , <br /> Nz-t-7 0 4 b y r u,04. rr e, W i 5 C <br /> q b �� Sanitary . : ;'ts <br /> CSM: LOT SUBDIVISION BLOCK/L ice_ (public,,get r) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / v 3 /CO / k 2 c I f� < S �1/ 4 y <br /> / C Zoning District R—� l"� <br /> . This project is a new building or structure. G ~ frx Permitted Use? 4, r w e_;i-oc,e, <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: at ISO r- <br /> Rural ' ••... <br /> EWER <br /> (new/ • ti :� <br /> gEPTIC <br /> � <br /> HEIGHT IN FEET: S NUMBER OF STORIES: (Not induding basement) <br /> / lr Wet land/Floodplain/ <br /> Shoreland (attachment) / <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: �ErosionControl permit <br /> Z_ <br /> 4 TOTAL SQUARE FOOTAGE: l (slopes,disturbance, V 6 <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: �J� <br /> / © AdReview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ and available options. A/IL_ <br /> (Please round to nearest dollar) aV 0/ ©� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes f:� o ❑Don't know <br /> 2. Is there twietland or floodplain on orpear the property? Dies * o ['Don't know <br /> 3. Have you 1lked with the township about your project and are they in agreement? g es I/ o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ►j es alo <br /> 5. Is this project associated with 3 rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ,-II o ['Don't know <br /> 7. Is this to correct a violation? ❑Yes rA o <br /> I'" C.' APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />