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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER E ` <br /> gt/Y1 Fii' (Z✓�l UVlA Zoning Status;CUP; 4 —•OWNER RESS (Number, City,State,Zip) _ --- ,,••n;CSM <br /> C06"11 tN\ f' i A �1 �- ( in) l 5-3W) U _; _ . ) <br /> HOME PHONE LL PH• E-MAIL ADDRESS <br /> III btj- (4) '' OWN AiNivA ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATIOid and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic . <br /> _ <br /> � e <br /> (City,State,Zip) (City,State,Zip) ! Setbacks 3 0 2.5 /0 3-0 <br /> PHONE PHONE iI_I Site Plan approval from / / <br /> applicable township. / <br /> A /- <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> r----,, 111 <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRE Z NING: ACREAGE: 12 Elevation of property <br /> ❑PARCEL (,1--3 le <br /> frontage drawn to sca . <br /> NUMBER 6 b f.- ' --0)',5- r <br /> TOWNSHIP: SECTIQN: <br /> U l/: t�4��: 0■4-0, Driveway permits <br /> ADD �T e, `` /' 535'10 - e COun <br /> V i 1 r v�.td%h( 5 I4 C t 54,/v,,f)vwi t-i t, Ill <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> 40(A �(� �� A', kit i (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: n. t,,,- / C/ /' �i .1,44:14 i � •- <br /> G 5 / 7 x / 2 K/ Z Zoning District A - 1 <br /> This project is a new building or structure. Xi Use? U,/� <br /> �, n <br /> is project is an addition/alteration to an existing building or structure. l <br /> SANITARY SERVICE: PERMIT NUMBER: N Rural Address <br /> [)EWER SEPTIC (ne alto <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 11'- tt7-- ( ) red W:,,. ..•plain/ /t�� <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shorel- d ttachment) /' <br /> (Outside dimensions including unfinished area,attached garages and above • -•- •_ .s or porches) <br /> BASEMENT: 1ST FLOOR: (� �ErosionControl permit <br /> i 10a , Ti .1 SQUARE FOOTAG . (slopes,disturbance,permit. <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 4 luta— i ■ 'eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: <br /> -0. -10 -10 -0. -0. -10 a d available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from - -••• • ..- ❑Yes 2No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ODn't o know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes to <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? IYes J( to <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) Dyes f Vo ®Don't know <br /> 7. Is this to correct a violation? ❑Yes EINo <br /> ',/2 2- ( 1 (2 <br /> APPLICATION MUST BE SIGNED <br /> ///^^^ ' i (Continue on Back) -4- <br /> 545712(4/08) <br /> C J G <br /> lG ()6 g ( 11 <br /> S <br />