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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 /> Seel..✓" 0/l l ur r k 6) ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Num er,Street,City,State,Zip) Deed Restriction; CSM <br /> .5-0 2 0 4. r•s4,41......,sew 14 cc. /4440,L sc..) Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> Got `R■24'i '3e,, ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AG NAME CONTRACTOR NAME <br /> �ri 0�#9 -�,� .r,� ❑ Site Plan including location <br /> AGENT A RESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Kitu#t Salt o o I ; '''M—?cc-( <br /> PHONE PHONE ❑ Site Plan approval from <br /> 601 W415 —o Si applicable township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 07/0 —05-1,0666-1-1 TR — ( , //Q frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: ❑ Driveway permits <br /> 3(Crilrc1 y� re t. '/a: '/a'/a: (state, county,town) <br /> ADDRESS: <br /> 3-2-4-( C kr t gV"`'`— "C ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> n A Ica.& kor - <br /> PROPOSED PROJECT INFORMATION 'STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ai1ue ii=v. 1\.i, 5A.,.._;._ I.odtc.e ex . of Dc.c( ❑ Zoning District . <br /> ❑This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> REWER r)EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment), <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) r; = <br /> BASEMENT: 1ST FLOOR: ❑ EfosIOnGOntrOi permit <br /> 4, TOTAL SQUARE FOOTAGE: ,' (slopes)idtsturbance, <br /> 2ND FLOOR: 3RD FLOOR: flllfng/access) ' <br /> e( silrt <br /> ❑ Review.Location.Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ / 7 5-6 , 6� and available options, <br /> (Please round to nearest dollar) �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? Eyes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Lives ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ❑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) Eyes ❑No ❑Don't know <br /> 7. Is this to correct a violation? Eves ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -* —► <br /> 545-112(4/08) <br />