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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAMES , l l <br /> O t) E we bur,V ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Nu ber,Street,Ciit`yy,''State,Dc /� 1,, Deed Restriction; CSM <br /> 5��NE I�-r `�er CELLePHONE�! S�U1 D) 1 ADDRESS <br /> l .J3 5g? Variance(# )AIL HOME <br /> !�73...91$U P5-3,,209-9 :. ,, <br /> 'via ❑Site Plan drawn to scale <br /> AGENT INFORMATION I 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 El Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <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 /> 4444�� <br /> {�j PARCEL NUMBE Ob io 35,94o 'as Q) foo RE 2, frontage drawn to scale. <br /> R <br /> TOWNSHIP: SECTI <br /> jj� ?J 14: '/414: ❑ Driveway permits <br /> ^�U n (state,county,town) <br /> ADDRESS: '7 / <br /> 3 Ca 7 Gu k V f ❑Sanitary permits <br /> CSM: LOT SUBDIVISION inANtj(`BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: l <br /> 54—b INASe J C`j0 ❑ Zoning District <br /> . <br /> This project is a new building or structure. <br /> ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ RuralAddress <br /> W <br /> EER REPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> if ( ❑ Wetland/Floodplain! <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: I—, ErosionControl permit <br /> Zen, ,, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> Z <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ j.,145-0Q Ol) <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 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? J Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes 'JNo <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 ININo ['Don't know <br /> 7. Is this to correct a violation? Dyes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />