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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTO A TO PROVIDE <br /> OWNER NAME C e i <br /> G►'' Pc `jj f oning Status; CUP; <br /> OWNER ADD S (Number,Street,City,State,Zi ) Deed Restriction; CSM <br /> 2 S (.tJ C)tfpQd PA, V riance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> i •^ / 00 — CioG i arN.'t'E < 2.2 t-/ <br /> 0A0°,cc y►. Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> C-CkY)-f-Cy( Phis I.,L�.. Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDB,ESS of well/septic <br /> 2-g`70 7-ems64 ,Sie. 1 . <br /> (City,State,Zip) (City,State,Zip) [Setbacks <br /> c uin Irt, i-a.z, 603- <br /> PHONE PHONE Site Plan approval from <br /> ���������� a•plicable township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> 01 I 1 e_ CO if 0( •eVl-LO Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ` Elevation of property <br /> PARCEL UMBER: ICURRENTZO ING: ACREAGE: I� p operty <br /> 0 NUMBER O3 8 Q 76 g'4 R-1•'2i 3 Y/~0 f ' -1 l J 't`f qT frontage drawn to scale. <br /> 6 <br /> TOWNSHIP: SECTION: <br /> ' I ku�m✓►. L 9 1/4: A,1 w '/4'/4: 6E" Driveway permits <br /> ADDRESS: (� '/ (state, county,town) <br /> 3K-3c s,,, b oa c / . V {`o"c,� ;WL c3313 unitary permits <br /> CSM: LOT 6UBDIVISION BLOCK/LOT <br /> (public, private) <br /> I 7Qrt Alf_ A L' <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION____..-- <br /> � �> � <br /> Y1 9 W;y,,.,m-;),S 120V-e- . <br /> Zoning Dstrict <br /> . Li This project is a new building or structure. (ermitted Use <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ -Rur ' s <br /> EWER �EPTIC (n /existtn ) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> .— etland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT Shorelartd (attachment) <br /> T: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT i_ 1ST FLOOR: - rosionControl permit <br /> - /� , TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> (ling/access) <br /> 2ND FLOOR: 3RD FLOOR: �, - <br /> /� <br /> - �-•G/ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: Q �/� V! t, ` and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ --► ♦ $ / U0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :]Yes No DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes ENo ©Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Elves ENo <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) Oyes 13No EDon't know <br /> 7. Is this to correct a violation? ElYes No <br /> 41( 9 0 , � / APPLICATION N M US T BE SIGNED <br /> (Continue on Back) -► -+ -0 <br /> 545-112(4/08) <br />