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ZONING PERMIT APPLICATION www.countyofdane.conl SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION _ .- . CUSTOMER TO PROVIDE• <br /> OWNER N E ^ <br /> V G t C 0 -k ❑Zoning Status; CUP; <br /> OWNERA RESS (Number treet,City,State,Zip) Q Deed Restriction; CSM <br /> y `i 3 e e �-. u( t SOS, , -ti( �� 7 � � Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> bOK Si 6 qi , T c it ho- —t c/.i et 06 Site Plan drawn to scale <br /> AGENT INFORMATION _ CONTRACTOR_INFORMATION "`7711""""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 JJJ❑I Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> ❑ Floor plans to scale <br /> 'PROPERTY/LOCATION.'INFORMATION ,:(http://accessdane.co.dane.wi.us/) : ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENTZONING: ACREAGE: <br /> ❑PARCEL �f o-09Z-q -0 P--3 . frontage drawn to scale. <br /> NUMBER <br /> TO IP: SECTION: <br /> ( -A 1/4: 1/4./4; ❑ Driveway permits <br /> ADDESS: (state, county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 7 309 2 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> P OJECT SC PTION: <br /> '' ..- (2..0 eCV S..0 ‘re C_\oS �e - a� -� esl-- lih//y/ dock U Zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted_Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEVVER 1—)EPTIC (newfexlstirli) <br /> �L� <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> I. ( ❑ Wetland/Floodplaln/ <br /> AREA TO NEAREST SQUARE FOOT SthOTeland (attachment) . <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) k <br /> ❑ Errs;OnCpntrol permit w <br /> BASEMENT: 1ST FLOOR: 4, TOTAL SQUARE FOOTAGE: + `� 5��pesp d stUrbanCe,t*r:• <br /> aret aceessx r '_ <br /> 2ND FLOOR: 3RD FLOOR: • , M a :1 <br /> l 2 ' ❑ Review l..ocatlon Survey <br /> ESTIMATED CONSTRUCTION COST: and aVai(eble options . <br /> (Please round to nearest dollar) '"+ ""∎ '♦ ♦ -0. --► $ ..3, dp0 <br /> S'R.4.0 <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 `ANo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 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) [hies gNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► <br /> 545-112(4/08) <br />