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ZONING PERMIT APPLICATION www.countyofdane.colll SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION , . _ ,'- CUSTOMER TO PROVIDE <br /> OWNER NAME � <br /> €04 /,0 4 /f e, ❑Zoning Status; CUP; <br /> OWNERADDRESS (Number,Street,City,ate,Zip) y l Deed Restriction; CSM <br /> WI Iii 441? c t -' � 511/C/7 Variance(# ) <br /> HOME PHONE CELLONE E-MAIL ADDRESS <br /> a -G Oo 15—cp c-/ <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTORINFORMATION and includes dimensions <br /> AGEN ME CON ACTORp AME <br /> Cl ? o 0 // G (i,f7 C/cdj// ❑ Site Plan including location <br /> AGENT ADD ESS C TRACTOR ADDRESS , well/septic <br /> / 2 f Oa fl/ 1-a4)/ I ? & C�'Dcf //-ect./)/ <br /> (City,State, ip) (City State,Zip) l <br /> ❑ Setbacks <br /> S State, ll, s'3� y id ciJ Gie-, �3Yy <br /> PHONE PHONE <br /> ❑Site Plan approval from <br /> 8 9C —��° 60 '-10po applicable township. <br /> E-MAILADDR E-MAIL ADD SS �- <br /> I d .e,.� dun _ / �,�J l— 0 ,I/ ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATiON,.(http://accessdane.co.dancwi.us/):. ❑ Elevation of property <br /> PARENT PARCEL N MBER: CURRENTZO iNG:• ACREAGE: <br /> Q �) (;J` frontage drawn to scale. <br /> TOINNSyn MBER 0G[/ G�/o/oc�'&ISG"UECTION: / , // <br /> I)I A,I(5 rryd,� '/4: '/41/4: ❑ Driveway permits <br /> ADDRESS: 6,, (state, county,town) <br /> �Q/ (1 Cf O/JSG/� ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, private) <br /> e;t •4 ii 14 fir Lo 97K <br /> PROPOSED PROJECT INFORMATION STAFF REVIEIW 7 <br /> PROJECT DESCRIPTION: <br /> 24 4ett/ ij0 at) 4�4.19 ai p Q g q <br /> to it c4.1�! ❑ t ZoningDlstrct <br /> • ❑This project is a new building or structure. ❑ +PermittedaU$e?.' <br /> his project is an addition/alteration to an existing building or structure. <br /> SANITARY SER E: PERMIT NUMBER: ❑ Rural Address <br /> `EWER r)EPTIC r- (newlexis"ting) <br /> HEIGHT IN FEET: I/ t NUMBER OF STORIES: (Not including basement) <br /> �,' _G / ❑ Wetland/Floodplain/ <br /> ' AREA TO NEAREST SQUARE FOOT: Sh.,—,, , (attachment) <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) EAoslonCpntrQl permit <br /> BASEMENT: , r- • 1ST FLOOR: `` SIO E-sL'itsturbance,` £ <br /> 4, TOTAL SQUARE FOOTAGE: 4, sgdis „, <br /> t f llmgtaccess)1Wi-tR*Y- <br /> 2ND FLOOR: 3RD FLOOR: * 4 g ' <br /> 7 6 f ❑ Revtevaocation Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ �OD „` and available options <br /> (Please round to nearest dollar) v . ,a <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des , o • ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Elves L( ]No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? .OYes ❑No <br /> 4.'Has there been a zoning permit issued for this property in the past 5 years? Des - No . <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) Des -ENo ['Don't know <br /> 7. Is this to correct a violation? ['Yes to <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -1 -► -► <br /> 545-112(4/08) <br />