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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> — <br /> ROPERTY OWNER INFORMATION ... , . . OFFICE USE ONLY y <br /> OWNER NAME , <br /> ' ' i x I, _ Zoning District C 2 <br /> OWNER ADDRESS (Number,Street,City,State.Zip) <br /> i _ 1 tc L. P,�C.t1_tc� t t-L' �l?,'3C r PermittedUse?t,t,/st 1/ <br /> PHONE E-MAIL ADDRESS() L I'1 S ( e `1 <br /> Zoning Status;CUP; r <br /> AGENT INFORMATION • CONTRACTOICINFORMATfON Deed Restriction; CSM <br /> AGENT NAME CONTRACTOR NAME - ,a_�r>! Variance(ft- _) <br /> r <br /> A . .1 { :,,c;CC )t t ii41Cre):- c Iv( �-}�) L`t1\-\ Inct6l1• ---- <br /> AGENT ADDRESS CONTRACTOR ADDRESS ',' Site Plan drawn to scale <br /> t - VVV��\ and includes dimensions <br /> ,� I .-� � , ► ,).�Il t„ fir. �z�l��► l t t i��,n r�l >>� --_. <br /> (City.State.Zip) l (City.Slate,ZIp) <br /> 1 L t L, /L1 c 11/ 1 t`1 t rk t. '6 If t E C, t �a I\A4_ `A I ' • .(Site Plan including location A/4 <br /> pfpNE 7 PHONE, L: of well/septic <br /> v E-MAIL ADDRESS E-MAIL ADDRESS ) / <br /> / y Setbacks <br /> k 4lit' 1111A`t 1 ( i11.-f". . ('i, ,\ --C l2 ` ICY) )f-tACT 11L"Y1`:,(C'„l <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) i:/ Site Plan approval from it <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE. L� applicable township. <br /> D PARCEL NUMBER <br /> i ',`14-,:L. I ..11 -(GC` LI �1 ( r' <br /> TOWNSHIP: SECTION: ( . Rural A <br /> L Z 1 `i 14: N E WC c:;titi (ne xlsti WY/i- <br /> t ADDRESS: <br /> Floor pla • : e <br /> CSM: LOT _-� SUBDIVISION BLOCK/LOT > <br /> j (.nrt 1 A' I ■ Elevation of property <br /> PROPOSED PROJECT INFORMATION frontage drawn to scale. <br /> PROJECT DESCRIPTION: 4)„ 1 , • r_ ((11yuttf`l_ Cll..'.. , ,c rrtact. C'(CXY I-,•,`/' <br /> i r;; 1 ,,(tr(0tinr)r�1 : /'t1 1 XDriveway mits <br /> ❑This project is a new building or structure. 7 (stat , oft ow <br /> This project is an addition/alteration to an existing building or structure. <br /> S,•• ,ry permits J�/ <br /> SANITARY SERVICE: PERMIT NUMBER: �r C,private) ' / ' <br /> El SEWER O SEPTIC <br /> r <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basemen!) loodplain/ Z 1 i <br /> YYY S foreland ttachment) /ir <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ErosionControl permit A /tA <br /> BASEMENT: 1ST FLOOR: ,, TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR' <br /> ,Review Location Survey ^/4_ <br /> ESTIMATED CONSTRUCTION COST: -4. ♦ -+ —I. —I" $ CO and available options. /lam <br /> (Please round to nearest dollar) W <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No .0 Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes U No U Don't know <br /> 3. Have you talked with the township about your project? 1Yes U No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes U 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? U Yes U No U Don't know <br /> 7. Is this correcting a violation? ❑Yes Li No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -+ —► <br /> 545-112(1108) <br />