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q-7 / <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION A CUSTOMER TO PROVIDE <br /> OWNER ADDRESS (Numb reet, ity,State, ) Zoning Status; CUP; <br /> ���VQ " / 'i 4 .5e /e / e,,,/q , 57-CR� `D peed Restriction; CSM <br /> /// (/ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> , 9- ‘4,5g..567 '/ w 3.79-91S2- E Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CO TRACTOR NAME <br /> /U/T1 ,c,P5_,,r� Site Plan including location <br /> AG T ADDRESS CONTRACTOR A R S f well/septic <br /> n /// /rasp �q' <br /> City,Slate,Zip) (City,State,Zip) etbacks <br /> PHONE PHONE Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> KFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of r <br /> PARENT PARCEL NUMBER: CUR NTZO ING: ACREAG p property <br /> ❑ PARCEL S ' (' aj <br /> NUMBER 4C0/ M ,1 5 S l / frontage drawn t0 scale. <br /> TOWNSH IP: / SEC ION• <br /> 5 /(//1// "xy -Q , 14: - <br /> 1/41/4:S E ❑ Drivew ermits <br /> "AD RESS: p (stat o nty,town) <br /> s� ` :reefs �A4,fe, /P� ❑ Sanita •ermits <br /> CS' / 0 LOT suBDIVISI�N, BLOCIVL•T (publi.,p 'vate) <br /> PROPOSED PROJECT INFORMATION STAFF R VIEW <br /> PROJECT DESCRIPTION: <br /> J .Se°,Sd v ,ce e n9 A Zoning District <br /> `This project is a new building or structure. <br /> 151:)ermitted Use? <br /> Al This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT�NU/M ❑ Rural ` i a <br /> ❑SEWER 'SEPTIC 1 v ( ='r 'sting <br /> HEIGHT IN FEET: s NUMBER 0 ST RIES: (Not including basement) A <br /> I)- ,�- - etl- •i ' a.gplam/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Sho --a (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,-a/_ros s t <br /> BASEMENT: 1ST FLOOR: (30 U'�� i 4, TOTAL SQUARE FOOTAGE: 4 (aS 04"=, +1'yt ah( ;` <br /> 2ND FLOOR: <br /> v�l 3RD FLOOR: 3© <br /> Pt Review Loca a -:‘• , <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ �� 1� and available options. <br /> (Please round to nearest dollar) I <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 ❑No ❑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) ❑Yes ❑No LI Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -i <br /> 545-112(4/08) ) ♦ <br />