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ZONING PERMIT APPLICATION ww.countyofdane.conl SUPPLEMENT to Web-App# <br /> w <br /> PROPERTY OWNER INFORMATION - - . . CUSTOMER TO PROVIDE <br /> OWNER NAME/� <br /> /-IMo .i Ai L-eA/0 ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State, p) Deed Restriction; CSM <br /> ill/ A A p A c/ AL Com b r ci I (' )I Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDR SS <br /> •• •�0F9 •-•"15•-•"15--4 5100/CVZ e (,YA5L. .66,-2 ❑ SitePlandrawntoscale• �,m,, ,, <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-MAILADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION.,.(httpa/accessdane .co.dane wi.us/) , Li Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER 651 a i&-i- /Q 4,' —3 ^E— 1 P .a frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> A t 6;61\) 1 Co 1/4: 1/a'/: ❑ Driveway permits <br /> ADDRESS: (state, county,town) <br /> 11 0 Alb►ot.1 Ret. ed`` u�r..! w1 53--3 El Sanitary permits <br /> CSM: LOT V SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: /' �� `,� I <br /> (SIC)-- l`oc-b r�r/ Pa\-e, '�∎l Q >0 ning D I2o strict <br /> . 71This project is a new building or structure. D Permitted:Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: :=© RUral Address <br /> DEVVER r)EPTIC (new/exiSting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 4r <br /> 1 a Q 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 /> Etos lonContti pe <br /> ❑ rmit <br /> BASEMENT: 1ST FLOOR: 1 TOTAL SQUARE FOOTAGE - `4 slopes djsturbance, <br /> . ,form jiaccess ' h <br /> 2ND FLOOR: 3RD FLOOR: = 3 . ,z <br /> S6a4 <br /> ❑ Revtew Locatlon'S u <br /> , Ney <br /> ESTIMATED CONSTRUCTION COST: $ and availableDpttons <br /> (Please round to nearest dollar) ♦ '♦ -+ ♦ -► ♦ �2 od <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Elves No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 1Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Des NINo . <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) Eves n1 o ['Don't know <br /> 7. Is this to correct a violation? Des �No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -4 -r► <br /> 545-112(4/08) <br />