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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME r 9 <br /> .- -..................._._._..-----_ _.._---__._.._._.........-----------..... ._�Q ...._....._...._.._........_..- - -- - -- �.1 Zoning Status; CUP; ?Po OWNER ADDRESS (Number.Street.City,State,Zip) Deed Restriction; CSM 7 <br /> ySy 6 ''�'"1e"' *, Variance(# <br /> HOME PHONE i CELL PHONE E-MAIL ADDR SS / <br /> a6Q-S793-702/7 SS Ch rn i t 7/ IS hoft�ai t• 604'1 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION 'and includes dimensions <br /> AGENT NAME CONTRACTOR NAME 7 <br /> Scv ct% CrLAil.Q.,^ , St o.S ._c c,a – – Sit : - '. luding to ation L� <br /> p • �i <br /> AGENT ADDRESS CONTRACTOR ADDRESS • well/septic <br /> (City State,Zip) (City,State,Zip) LSetb� y V <br /> � <br /> PHONE — PHONE Site Plan approval from 1/ <br /> applicable township. /V <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> gFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdana.co.dane.wl.us/) Elevation of property /9 <br /> PARENT PARCEL NUMBER. CURRENTZONING ACREAGE <br /> ❑PARCEL n ( 77 frontage drawn to scale. <br /> --- NUMBER---- Q !�l_d 3y_ �l / I-9 -----R-1 a ��y <br /> TOWNSHIP SECTION <br /> COIfa9t_ -rove 03 %: SE '/1/4: SE 0Driveway permit <br /> ADDRESS (state, county, • <br /> 1/541G /4rvies"Cctvl Ott gSanitary .- -:"ts <br /> CSM- LOT l� SUBDIVISION IBLOCKILOT (publi., private <br /> I? /Tm�%cct✓1 Ili'rI l�J <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> i.PROJECT DESCRIPTION: / I / n <br /> -- _ <br /> /0 'x 16 Si-cra5� Sked _ AO X 10 X gS .Zoning District ' "f <br /> 'This project is a new building or structure. �� S S?0 r *, Permitted Use? f25 2 <br /> This project is an addition/alteration to an existing building or structure. S <br /> SANITARY SERVICE: PERMIT NUMBER ( Rural Add - <br /> FIEWER I– EPTIC (new - <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 'f+ perk Ae15i,±_ f Xwetialci/Floodplain, /1 <br /> Shoreland (attachment) Pr- <br /> , <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: <br /> rosienControl permit <br /> 160 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, t <br /> 2ND FLOUR: 3RD FLOOR filling/access) 4/9,/ <br /> 160 <br /> f <br /> , Review Lo cn Survey , <br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ♦ .. ♦ / rl and available options. / / <br /> (Please round to nearest dollar) O �� 1 Q �J <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ao ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes 2INo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ;❑S'es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? rives ,2 Jo <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) Elves „ONo ❑Don't know <br /> 7. Is this to correct a violation? Lives ,ao <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) - <br /> 545-112(4/08) <br />