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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME I <br /> MATT " t&IaC�1 W 120kvivi/tF IYZoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> -1-4. MIPrh)t,E.%.1 Ova, Sa NI TY C t lr-)�. Fi 7-,S`IU Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> • 14 • 231— z34T (0,$ - 211-3442- MU.NirsAKACAC.0AStrUtho- 4) 0' Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME C NTRACTOR NAME �/ <br /> Giwook 6 howl i CI\pLi14t„ Po01.1 U_- L/ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 21510 T P a. S • IZ <br /> (City,State,Zip) (City,State,Zip) Q'Setbacks <br /> Sow Pn tt,t - ( v. _ 53sl() <br /> PHONE PHONE 0 Site Plan approval from <br /> (t()°u • (62S . 116-15 applicable town ip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> L • .1 ,COAN ❑ Floor plan o ale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevat on f prop <br /> W <br /> NUMBER <br /> (�I I IUZ-7'�(St-U IZkh'iAF'Nrs4.o0.� 0,°I fronta draw o scale. <br /> TOWNSHIP: SECTION: <br /> OF (-70,\‘ 9VVATA ' 10 '/a: NI4 WA: NHS ❑ Driveway rmit <br /> ADDRESS: (state, unty own) <br /> Z;i; it PV■I L -( DILL ❑ nitary ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> T F�. IST PIOIVFal IL (public private) <br /> F.-. FvD 12 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: p mu �, /5 g Disc <br /> � .Ontn <br /> ❑This project is a new building or structure. 17. .erm• <br /> (A This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural ddress <br /> ❑SEWER L SEPTIC U�2-) (new/ xisting) <br /> HEIGHT IN FEET: l NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/F lain/ <br /> Shorela attach nt) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 1--, ErosionContro eermit <br /> j TOTAL SQUARE FOOTAGE: l (slopes,di *sane, <br /> 2ND FLOOR: 3RD FLOOR: <br /> 4/`(` filling/a *3- ) , <br /> )` ❑ Revi- Location Survey (..) <br /> ESTIMATED CONSTRUCTION COST: p I Uv� ,i•�; and available options. <br /> (Please round to nearest dollar) Il <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 4a, ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? �❑,Yes 1 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Les 0, <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes IJ No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blankf none) <br /> 6. Is a location survey required? (see reverse) ❑Yes INI yo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes lb No <br /> APPLICATION MUST BE SIGNED LI CS <br /> 545-112(4/08) '1 iii (Continue on Back) ♦ ■ -♦ <br />