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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 /> C o U " \(vthA� %Zoning Status;CUP; A --OWNER ADDRESS (Number, t ity/ °,zip) �� l ry Deed Restriction;CSM / <br /> f-O "1 1-11.I 1 lY !fit�1� �uh �f / 5 3 S 1 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADD SS <br /> 7/)-.(j� S p, I or/eq./11,4i .601-% / Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions // <br /> AGENT NAME ►s 1 , CONTRACTOR NAME(' /(/ <br /> V V J U�ite Nip.- .ing locatio <br /> AGENT ADDRESS CONTRACTOR ADD13ESS A �vC of wel�r-eptic /Ac <br /> (City,State,Zip) (City,State,Zip) 55TTnnll��l, f� Setbacks y/y �-- <br /> PHONE PHONE ,gkite Plan approval from i/4 <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> g'Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) // <br /> PARENT PARCEL NUMBER: / CURRENT Z IN : ACREAGE: Elevation of property <br /> 0 NUMBER d PI t 1.gZr- (I" i -� 0'if/ frontage drawn to s <br /> TOWNSHIP: SECTION: �� r <br /> $r�5i-o w' /4: V Y�► '/4'/: 2°1 ZDriveway permits <br /> ADDRESS:', ,n f I.t c J� Waif ie,�L s f(� (state,county, at <br /> CSM: �0/4'�II LOT SUBDIVISION BLOCK/LOT Sanitary •-wits <br /> t+i��0� c� (publ <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: li I 11 ��� / ,/ L ll JJ 1,t1 k <br /> papioj, 0051 fl l-w x (8"0 S ' L a bid_illy /�f- jG2d-o c�MGG Zoning District <br /> This project is a new uilding or structure. Z n !X (9 'x 1 I De-1" ,. -5 d 455taii <br /> r/ Lermltted Use? c e <br /> This project is an addition/alteration to an existing building or structure. Sft?r S' <br /> SANITARY SERVICE: PERMIT NUMBER Rura '��0 EWER iEPTIC I 1 (new rte" <br /> HEIGHT IN FEET: I NUMBER OF STORIES: (Not including basement) <br /> ii I Aim ?•.. Floodplain/ OA <br /> AREA TO NEAREST SQUARE FOOT: <br /> orela�.►(attachment) I„ <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: J 1ST FLOOR: ErosionContrrol permit r-- <br /> V A 4, TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> filling/access) ©,1, <br /> 2ND FLOOR: - /J& 3RD FLOOR: , ri f t ^ �" <br /> tn//t/ N`I Iht` ov(v/ ,Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ and available options. f D ii <br /> (Please round to nearest dollar) $ � <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes IVo Don't know <br /> 2. Is there a wetland or floodplain on or near the property? es to �on't know <br /> 3. Have you talked with the township about your project and are they in agreement? es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es Cl o <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) Wes alo ['Don't know <br /> 7. Is this to correct a violation? es ■10 <br /> 11 7` I <br /> Z l3 4 3i — /( 1-- APPLICATION MUST BE SIGNED <br /> u5 112µroe) /Z (Continue on Back) -► ♦ -i <br /> IZ '? 2$ <br />