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ZONING PERMIT APPLICATION www.countyofdane.coll1 SUPPLEMENT to Web-App It <br /> PROPERTY OWNER INFORMATION . __ C TOMER TO PROVIDE <br /> OWNER NAME <br /> I -bro\ M ( C /_, Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 53a, C 2d .-f ariance(# ) <br /> HOME PHONE C LL PHONE E-MAILADDRESS <br /> BUY SQL DOE Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR._INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS • f well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE Site Plan a oval from <br /> applica township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> F or plans to scale <br /> PROPERTY/LOCATION,INFORMATION°:,.(http://accessdane.co:dane.wi.us/)_ levation of property <br /> PARENT PARCEL N MBER: C RRENT2ONING: ACREAGE: <br /> ElPARCEL Q I aL/ ? 90t.) �.,( . 1((0 frontage drawn to scale. <br /> NUMBER ��JJ�U !J o{ mac• J Q� l <br /> TOWNSHIP: SECT O ` 1 <br /> Cj(�p P ,ryP C� 1/4:�� '/%: W ❑ Dnvewa ermits <br /> A1,0 J (state OUn own) <br /> ADDRESS: <br /> ..3— er • —Tr /1.Gr )/ VV l s, 59 ❑ Sani permits <br /> CSM: LOT ; SUBDIVISION BLOCK/LOT (p.alic, private) <br /> PROPOSED PROJECT INFORMATION 4 <br /> STAFF:REVIEW <br /> PROJECT DESCRIPTION: / / / <br /> Le01 V\ — OtdCl(-f(t�'n, lb 7( 1� �4oning Distract - <br /> . ❑This project is a new building or structure. 0 Permitted'rs <br /> This project is an addition/alteration to an existing building or structur <br /> SANITARY SERVICE: PERMIT NUMBER: L Rt�ral ddreS <br /> . 1.- EWER [EPTIC (new IStIr <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) U. Wetland/F odplain/ y <br /> AREA TO NEAREST SQUARE FOOT: Shorel d (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) . <br /> BASEMENT: 1ST FLOOR: '/-- <br /> Q EE.osionCOn permit <br /> r <br /> j TOTAL SQUARE FOOTAGE: ,` ` 'kSIOpeS'' urbance, <br /> /n �_ fillrrng cessT . <br /> 2ND FLOOR: 3RD FLOOR: �) = 1 4.L ' u , <br /> ❑ Re iew LocetionSurvey_ <br /> ESTIMATED CONSTRUCTION COST: q O and avaiilablemptions <br /> 3 } .r �`: <br /> (Please round to nearest dollar) .� :, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? tz# es ONo • ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? ►i es „2No ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ,114i'es ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? .Yes ONO . <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 ANNo ODon't know <br /> 7. Is this to correct a violation? QYes .No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► --0 -1 <br /> 545-112(4/08) <br />