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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENTto:Webapp# <br /> :PROPERTY..OWNERINFORMATION -__. ,.: - s }': ''''t .' , <br /> OFF'ICEs,USE.'O�ILY-' <br /> OWNER NAME '�r� <br /> D' I A R W,lPr�l�1 ❑ Zoning District <br /> OWNER ADDRESS (Number, eel,City,State,Zip) <br /> 2_1-1 g\ L AP►Son 1 W1 531/3 ❑.Permitted Use?, <br /> PHONE E-MAIL ADDRESS <br /> C — 21 L .T _ —' ❑ Zoning Status= CUP <br /> AGENT INFORMATION <,. " _. .'- ;CONTRACTOR;"..INFORMATION� I,J :. �=;�a*_' •;,DeedRestriction; CSM <br /> CONTRACTOR NAME <br /> Vaace )AG NT NAME <br /> �� ��� .n ,„ <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> 5�1� � �� ❑ Slte Plan drawn,to scale <br /> �_ ` :ar d includes dimensions <br /> (City,Stale,Zip (City,State,Zip) <br /> �Qq-ine ■.■-1 `J 3S40 ❑ Site Plan i'ncluding location.. <br /> PHONE PHONE of well/septic <br /> E-MAILADDRESS E-MAILADDRESS ❑`Setbacks <br /> i'j{ are ,4 t4 Q(� C kr',n ef- <br /> PROPERTY'/LOCATIONINFORMATION;? (httpd//accessdanecoaanewl us�� 1.':' `;`,❑;Site Plan;approval from <br /> PARENT PARCEL NUMBER: Q 3 ZONING: ACREAGE: < ,applicable'townsft <br /> NUMBER •I O A��— / J "� <br /> TOWNSHIP: SECTION: 1 ❑ RUraj/�ddf2S5 <br /> . 'V 0 1/41/4: 1J. ar <br /> D u>nn alp /4 (new/existing) <br /> ADDRESS: <br /> �� 0 L� S�� hFDn lIJ 1 �J S'' F❑ Floor}plans to scale <br /> CSM: LOT BDI ISION BLOCK/LOT :' ii ? <br /> ©o ( C So I Li,Elevation:of property <br /> PROPOSED'PROJECT INFORMATION. :: '''' :') ._- frontage drawn to Scale <br /> PROJECT DESCRIPTION: <br /> I <br /> L r < 1pt k Li.” 5 1 D,'Drlveway permJts <br /> .This project is a new building or structure. (stake, county town) <br /> f ` `C p <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> ."❑s Sar'utary�perrnits <br /> SANITARY SERVICE: PERMIT NUMBER: (public, private = <br /> SEWER ❑SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ❑ Wetlajld/1=l0odplln/ <br /> � ( <br /> Shorelan'd (attachment): <br /> A # y3 <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) " °` <br /> ( g ❑ ErosionControl permit <br /> BASEMENT 1ST FLOOR: (slo,peSi diSturbapce, <br /> j, TOTAL SQUARE FOOTAGE 4 <br /> fllling/acgess) �` <br /> 2ND FLOOR: 3RD FLOOR: 9, f r X11 ,, t- <br /> (..� ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: $ �1 5D and available opt onS <br /> (Please round to nearest dollar) -► ♦ ♦ ♦ -► ♦ tx <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes allo ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes (eNo ❑Don't know <br /> 3. Have you talked with the township about your project? Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 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? CI Yes �No <br /> ST BE SIGNED <br /> ► <br /> (Continue APPLICATION BMU on ack) —► — <br />