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ZONING PERMIT APPLICATION www SUPPLEMENT to Web-A pp #.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> T /n� <br /> z)MA5 /, 'F R5T'ES ❑Zoning Status; CUP; <br /> OWNER' ADDRESS (Number,Street,City,State,Zip} Deed Restriction; CSM <br /> 1`T Sg Al L` ?..—C9 LL E-MAIL tn�� 3 �J Variance(# ) <br /> HOME PHONE CELL PHONE? E ADDRESS <br /> (p 'cJI I" � °98 Orr►@ o►M wRS►�f�Cb►J�i�UC"'1DI),W�❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 5PlY\ Ce FOE_ Q Ce ►JSTQ.t,kc�pti L,L. ❑Site Plan including location <br /> AGENT ADDRESS (CONTRA TOR ADDRESS of well/septic <br /> P,O Zip)( '7 <br /> (City.State,Zip) (City,Stat ,Zip) _ El Setbacks <br /> PHONE PHONE � 5357 5 ❑Site Plan approval from <br /> (DOs a1 l- Qoc8 applicable township. <br /> E-MAILADDRESS E-MAIL ADDRE S 1. <br /> IcMe .m I etS`4K(lDn ?DILc't'ioa,con ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT P RCEL�NUMBER: CURRENT ZONING: ACREAGE. <br /> ❑NUMBER C X11 J 1 a.'��f=b21-C 7,-1 I O 4 538 frontage drawn to scale. <br /> TOWNSHIP: SECTIO <br /> ALB 10)J _ 1,,: 5 /4/4: 5 E ❑ Driveway permits <br /> ADDRESS/! G 1�D (state, county, town) <br /> vl ❑Sanitary permits <br /> CSM: LOT S BDIVI4ION.- WS BLOCK/LOT <br /> LUt MtA�o a (public, private) <br /> �,Tfs <br /> PROPOSED PROJECT INFORMATION ST> f t��lIEW <br /> PROJECT DESCRIPTION: <br /> }. ,‘,J 5/1.1G t✓-e FA /�Y o uJ t u)�C. zoning District <br /> . <br /> ; his project is a new building or structure. <br /> U Permitted Use? <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE PERMIT NUMBER � © Rural Address <br /> FIEWER EPTIC / S a- /6 .— C© /(1 2_ (new/existing) <br /> HEIGHT IN FEET. J ///���������YY NUMBER'OF STORIES: (Not including basement) <br /> ZS— ) _ U`1�and/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) al Erpeipricontr©i permit <br /> BASEMENT. O I 1ST FLOOR:^ TOTAL SQUARE FOOTAGE: j (slopes,distubance, <br /> 5 fltinglacs) <br /> 2ND FLOOR' 3RD FLOOR: 5?5/ , <br /> 7 l Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ' and available options. <br /> (Please round to nearest dollar) $ 275-/000 <br /> 1. The property is within 300 feet of a stream or 100 feet from a pond or lake? ❑Yes OPio ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the pro erty? ❑Yes No ❑Don't know <br /> 3. Have yo ,u talked with the township about your proj ct and are they in agreement'? Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Eyes , 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) Lfres I o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ►. o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ - -+ <br /> 545-112(4/08) <br />