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ZONING PERMIT APPLICATION www.countyofdane.com -SUPPLEMENT to Web App# <br /> PROPERTY.OWNER:IN<ORMATION ` ..;___. '.';J ,I, '..` ` . .'°: t,' OFFICE USE:.ONLY <br /> OWNER NA <br /> 1 ` ' <br /> � t,'-3 \_\_,e...i . ..../....v.__ ❑ zoning District <br /> OWNER ADDRESS (Num ei,Stied,City,State,Zip) <br /> C31bt Ct ak41\ -S t.A-°e- SoUGN11)4 I LO 53S�9 L Permitted Use?" <br /> PHONE E-MAIL ADDRESS 't <br /> 1 0 zoning,Statu Status; <br /> �Q�- �s7�j— 77 a� Vr¢.�komeSQles Oho�aiA1 60v� UP; <br /> AGENT-INFORMATION °i` ` CONTRACTOR`INFORMATIONk. �,, ;' . �. Deed_Restric ; CSM <br /> A ENT NAME CONTRACTOR NAME Variance,(# ) <br /> ,Nor c) 7,----- E �r4vnQ <br /> AGENT ADDRESS CONTRACTOR ADDRESS ❑ Site Plan,drawn to scale <br /> G�'b Re-tAer _ 7 and Includes dimensions . <br /> (City,State,Zip) (City,State,Zip) ' <br /> 'Sv� 2 j _�i -3'S-.PO ❑ Site Plan Including location <br /> PHONE PHONE of well/septic <br /> \� s ac-- ti m- <br /> E-MAILADDRESS E-MAILADDRESS ❑ Setbacks <br /> �( are ,�-iiU Q cAA-(V•cr. ri e-4- :Y. <br /> PROPERTY/LOCATION'JNFORMATION !�(ht tpgllaccessdane coalainewiaus/) }:1' Li Site Plan approval from <br /> PARENT PARCEL NUMBER: ZONING: (�( ACREAGE:(- applicable township <br /> ID PARCEL �1ol0_IR(0 -R( o_ 3 �_ 1 �Y <br /> NUMBER <br /> TOWNSHIP: SECTION: A, ' \ �' .- Rural Address , <br /> a u 1A: NA LL) 1Y41,4: `)�/ <br /> 1 V Y7 (newfexlstng) <br /> ADDRESS: t <br /> i01Q �,�(\e `-A n,e 5'T- V 4-fo'J 1 w l �J 3 �1 0 loor'plans to scale <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 00 11P c 3 q A�I v a Elevation,,of property <br /> PROPOSED PROJECT INFORMATION ( frontage drawn to scale. <br /> PROJECT DESCRIPTION: 1 <br /> �?TSi "A 5a r in t.))1 erne)10 )(ii De. v U-1 St t �r t�or j�ed iv1 5I-- 0S -o QnvewaY'permits, <br /> . ®This project is a new building or structure. (state, cotanty town) <br /> ❑This project is an addition/alteration to an existing building or structure. °©,-Sanitary perrnits <br /> SANITARY SERVICE: PERMIT NUMBER: (pliblib,private) <br /> 10 SEWER Li SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) -0 Wetla d/Fjlood lain/ <br /> 14 r _ "Shore and (attachment) <br /> AREA TO NEAREST SQUARE FOOT: " si 'i <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ;,L ErdSloncontrol permit <br /> BASEMENT: 1ST FLOOR: (S1OpeSi disturbar.tce, <br /> �� TOTAL SQUARE FOOTAGE: <br /> fiillrig/acoessj <br /> 2ND FLOOR: - 3RD FLOOR: _ \\I) <br /> r ,� � <br /> �J 0_Review Location`Survey. <br /> ESTIMATED CONSTRUCTION COST: __ ♦ __ _♦ $ and available options <br /> (Please round to nearest dollar) �� "`` "` s"""" <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. There is a wetland or floodplain on or near the property? ❑Yes ®No ❑Don't know <br /> 3. Have you talked with the township about your project? <br /> 41 <br /> Has 4. Has there been a zoning permit issued for this property in the past 5 years? <br /> CI-Yes <br /> �No <br /> 5. This project is associated with.a rezone/CUP/variance (petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes ®No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes No <br /> BE SIGNED- - <br /> (Continue APPLICATION on Back)MUST -► ► ► <br />