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ZONING PERMIT APPLICATION www.countyofdane.cotll •SUPPLEMENT to Web•App # <br /> PROPERTY OWNER INFORMATION _ CUSTOMER TO PROVIDE <br /> OWNER NAME ` ` 1 1 i -} A —/ - <br /> v c1 m 3- - B a YNie f f Zoning Status; CUP; ,�/� <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> CYc : ej N'd , EG v cm ] 6(0• C3534/ Variance(# ) <br /> FjOME PHONE 9 ill CELL P151 9,6 t 2. E-PIA,IL ADDRESS <br /> 1/!✓Y1p0 CO,r�•' (/�`/1OD ' Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR_INFORMATION and includes dimensions �-✓L. <br /> AGENT NAME CONTRACTOR NAME <br /> (Site Rao uding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of - /septic <br /> r -v G 3/3 0/�o <br /> (Citq,State,Yip)*' ` ` ' ' (City,State,Zip) 0 Setbacks <br /> PHONE , PHONE ire, Site Plan approval from A / <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale //`�/ <br /> PROPERTY/LOCATION.INFORMATION,::(http:pacOetsdine.co.dOne.wi.us/),:. �� Elevation of property T <br /> A. a PARENT , PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> LiPARCEL o5%1. ►2y—atop% -D A-4 Ex 3g-s' frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> pt...ZA D,.., l Z '/4: E- 1/41/4: Driveway permits <br /> ADDRESS: � (state, coup 46 <br /> CSM: OT GAD1 4UBDI,VISION BLOCK/LOT III Sanitary •;;._u.ts <br /> (publi•,g) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: 3- <br /> 3�� Z G ,k Zoning Dlarlct 4:-.,_i‹. <br /> A;,..i,..{,;:,.7.:4N;:oiottgARRMaWi!, :m 1 <br /> . <br /> This project is a new building or structure. S `" Permitted Uses t .-4. <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: I � <br /> �yL, RUI'al 5 <br /> r)EWER /y(�EPTIC (n8 ! 1 <br /> v <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 2 �� •dplain/ ' y <br /> ore)a®. ttachment) <br /> AREA TO NEAREST SQUARE FOOT: �� <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> *CosionContrpl permit <br /> BASEMENT: • 1ST FLOOR: �� �- " <br /> 3 2 0 0 4, TOTAL SQUARE FOOTAGE: 4 cslxopeS Clisturbahoie, �, <br /> Ilmgl-access i <br /> 2ND FLOOR: 3RD FLOOR: /1 ��j 4, r _' 7 <br /> V Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: $ 25OO, 01 nv .options v v r <br /> q- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Wes QNo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes fNo oDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Wes QNo <br /> 4.'Has.there been a zoning permit issued for this property in the past 5 years? QYes S]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) QYes -SNo ❑Don't know <br /> 7. Is this to correct a violation? 6„ Des 'cINo <br /> ti <br /> APPLICATION MUST BE SIGNED <br /> 3 yv - (Continue on Back) --4. --I.--I. -♦ <br /> 545-112(41o8) .C�//'1 <br />