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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 /> pet- � kr ❑Zoning Status; CUP; <br /> OWNER ADDREumber,Street, ity,State,Zip) Deed Restriction; CSM <br /> /&23 s" Sc e.ic4••4 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ,h' 71 ST-cA,(„9 ‘..e6. 332• $53- ❑ 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-MAILADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/), ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> El NUM ER D 3(//9806/l)3-Zirz-3 / 7 j frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> • <br /> MeNZaAAanlc ,/<: '/41/4: ❑ Driveway permits <br /> ADDRESS: (state, county, town) <br /> /c�2.35- Sc.►,bcnc --...,-1 7,X. <br /> El Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION `.STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Zc5r.Sb .17,1. ��.„k, ....c64)",..4."4.,}1, Pc* ❑ Zoning District <br /> BThis 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: ural Add <br /> Li Rress <br /> FTEINER SEPTIC 1 (neW/existing) , <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> Z ❑ Wetland/F000dplain/, <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ Erosic nControf permit , <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: f Iling/BCCeSS� ' <br /> ❑ Review Locations Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) -9 ∎ —0 --► -.► ♦ $ 3S 1> > <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? ❑Yes ENo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? EYes ❑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) ❑Yes ❑No ]Don't know <br /> 7. Is this to correct a violation? [Yes ON <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i► -* -♦ <br /> 545-112(4/08) <br />