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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION - - . . - CUSTOMER TO PROVIDE <br /> OWNER NAME �`� , ' <br /> C UO _1 c -1 l/L1 S ❑Zoning Status; CUP; <br /> OWNER ADORES (Number,Street,City,State,Zip) i rs,e, n I,,,� l Deed Restriction; CSM <br /> ( V� Mr LO U111 ( w I S8 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ( O% ,'0-1•L(°(3 . # £Y3 . 'M&A 1. 1-014-1 ❑Site Plan drawn to scale <br /> 'AGENT INFORMATION CONTRACTOR:INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> • ❑ Floor plans to scale <br /> PROPERTY/LOCATION.INFORMATION,:.(http:Paccespdane.co.clane.wLus/), ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ElPARCEL NUMBER 00/Ui io-35 --(11sb 5 ..„..9„, <br /> NUMBER 0,3(P61 frontage drawn to scale. <br /> ADDRESS: <br /> EODYY i e SECTION: <br /> (�rpJLJ V 5 ❑ Driveway permits <br /> 9 a '/a: '/a'/a: (state, county,town) <br /> ADDRESS: ��" <br /> ;5(/� C A v t(/tip% ivt ❑Sanitary permits <br /> CSM: LOT SUBDIVISION .P1pf j( BLOCK/LOT (public, private) <br /> 13 , fiJ►► }H <br /> PROPOSED PROJECT INFORMATION STAFF,REVIEW <br /> PROJECT DESCRIPTION: <br /> I <br /> �� <br /> �,� Zoning DlstrJCt ` <br /> 4E - <br /> . jZThis project is a new building or structure. 0 XPermitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ,© RuIa!Addre$5 <br /> FIEWER TiVrlpw/exIsting);.;; <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplam/ <br /> AREA TO NEAREST SQUARE FOOT: ShOr"eland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) =' <br /> ❑ ErosionQoutrol permit <br /> BASEMENT: • 1ST FLOOR: <br /> 4. TOTAL SQUARE FOOTAGE ` slo e �'dis� <br /> urbatice * <br /> illrng(access)'� L --. <br /> 2ND FLOOR: 3RD FLOOR: 'Q § V ;' <br /> .t <br /> 0 Revlevv Location Survey' <br /> ESTIMATED CONSTRUCTION COST: d i � and avallable-opfions <br /> -► .-► ♦ ♦ --► --► �'P <br /> (Please round to nearest dollar) -: ,x._. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Eves ,®,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? Wes 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 `®N° ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 21No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -I -♦ <br /> 545-112 14/05) <br />