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ZONING PERMIT APPLICATION www.countyofdane.conl SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION _• .. - CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> -; c (6 •a c /) - ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> ,n )6 c-.55 C • ' Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (-r"u/ - 3% 3 - )/iJ ❑ Site Plan drawn to scale <br /> AGENT-INFORMATION ti.,.... .a CONTRACTOR_INFORMATION and includes dimensions <br /> AGENT NAME CONTRAC OR NAME / <br /> L' �:J �.- : ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS • of well/septic <br /> 17 .7 /1 c_ _ it, L..... <br /> (City,State,Zip) (City,State,''Zip) ❑ Setbacks <br /> -y 7e,!.,_ 1 ----7 �- 3 .s S,"l <br /> PHONE PHONE ❑ Site Plan approval from <br /> 6 Jr - /3 -1// }"7 applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION.INFORMATION-. (http://accessdane.co:dane.wi.us!)_ <br /> PARENT PARCEL NUMBER: CURRENT ONING: ACREAGE: ❑ Elevation of property <br /> ❑NUM ER a�so' 2-a'xo 3 r - frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> IvvJ ,�: '/4�/4: ❑ Driveway permits <br /> ADDRESS: (state, county,town) <br /> • <br /> E,02. 13#4s5 ctrl. ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> • <br /> PROPOSED PROJECT INFORMATION !STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ce Vt, tt...0 .tom BSI �w5� Zoning District <br /> . [ This project is a new building or structure. . 0 Permitted:Use? <br /> ❑This project is an addition/alteration to an existing.building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Rural Address <br /> . ■EWER r)EPTIC (new/existing) r <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplaln/ <br /> AREA TO NEAREST SQUARE FOOT ShOrelandattaChment) <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> 0 EroS)onControl permit <br /> BASEMENT: , . 1ST FLOOR: 1 TOTAL SQUARE FOOTAGE j _ `;Islopes disturbat ce, <br /> �fll)nglaccess)' 1a ° - _ <br /> 2ND FLOOR: 3RD FLOOR: , 1 *. _� ,. <br /> s <br /> V❑ Review Location•Survey _ <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ �,� a� and avaiiableoptions <br /> (Please round to nearest dollar) v Y <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? ❑Yes ❑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? [Iles 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) ❑Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —9 <br /> 545-112 14/08) . <br />