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ZONING PERMIT APPLICATION www.countyofdane.com <br /> I <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME pp (/�� ��^^ A % /_� <br /> �c7b �9 �cvtll.'tc•� l_.os- SS [Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street.City,State,Zip) eed Restriction;CSM <br /> (251 C kd by-e i (...,..1, S-3S7 Variance(# ) <br /> HOME PHONE CELL P ZONE E-MAIL ADDRESS ll <br /> (,0ij �ZS—q Sc 1O1 4 V € t6TIh�.,I , L-o' n Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CO TR,S 1 <br /> t�TOR NAM <br /> 4tket.) (`e1^� ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 0667 Co,ccvd Dr.',/<. <br /> (City,State,Zip) (City.,Stat Zip) ,f/ Setbacks 2 2-/V <br /> Lict■ , c-J.T, S3S?5- ,s-o ,3g" <br /> PHONE PHONE * Site Plan approval from <br /> (608) `f 8ol ^ OSBa applicable township. f s <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> AAR(C KEPT 9-3 Q L+ 'I•COM ,Floor plans to scale • /6, <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: q CURR TZONING: ACREAGE: P P Y <br /> ❑PARCEL f�.S�O F 112-YP 0._/ A ^/��� + S^ 2 V frontage drawn to scale <br /> NUMBER <br /> TO�S HIP: � SECTI <br /> ` re-CI w %: /1/ 1�41�4. .0 ^ <br /> kfDrivewrnits <br /> ADDRESS: (state, oun ,town) <br /> 0-51 C1, ltd t 0,-c c I LS. S3 s'7 S <br /> C <br /> er <br /> SM: LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> ��'' (public a - <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: f // / /) 7 /X ��/ e ` ^ <br /> c-.'o✓ 4c /�/[ � D "/K` Zoning District /,'LJl `K� <br /> . ❑This project is a new building or structure. 1.0 / _'L✓/2— S-�e�S le. �L <br /> Permltted Use? e <br /> This project is an addition/alteration to an existing building or structure. ,�( <br /> SANITARY SERVICE: PERMIT NUMBER: JC1 Rural Add 'SS <br /> n;EWER ZEPTIC (new/: Isting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) . <br /> ,Z— / Wetland/Floodplain/ /� <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages nd above gr cd ks or porches) _ErosionCOntrol permit <br /> BASEMENT: 1ST FLOOR: '. / S <br /> / (4 �fTOT SQUARE FOOTAGE: j (slopes,disturbance, i�C' i <br /> 2ND FLOOR: 3RD FLOOR: (2 643 �/�` filling/access) /T�� I. <br /> � ft ❑ Review Location Survey <br /> ESTIMATED ED CONSTRUCTION)COST: ♦ ♦ nl O� and available options. <br /> (Please round to nearest dollar) o <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 EDon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Efres 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 go ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 'Jo <br /> $ S i ()--1— APP•CATION MUST BE SIGNED <br /> (Cont nue on Back) <br /> 545-112(4/08) <br />