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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> i!/ -Ie-A{ liK 1 1074 SA. \'" ")1, (-A ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction SM Ic/ e fi e_ ADDRESS, /4c F �0 Variance(# <br /> )HOME PHONE CELL E-MAIL <br /> °3 V - ._.) ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 20'35' cm-t-,c-T=om `` > ❑ Site Plan including location <br /> AGENT ADDRESS CONTRA TOR ADDRESS of well/septic <br /> 7o/ er• ki,t-S,p /j ,44\4.-S' '----- <br /> (City,State,Zip) (City,Stat ,Zip) ❑ Setbacks <br /> O/ s 3J (/J , 53 70 3 - 2 <br /> PHONE PHONE ❑ Site Plan approval from <br /> (p n zs7.0 50-o 7' applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> -A,1 v)�g;• c0�� ,c•-�z.c�/,�,��--7 ? ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURREN,ZONING: ACREAGE: P p y <br /> ❑ UM BE (jag/b(.')0 -07/ 5t'b E- frontage drawn to scale. <br /> TOWNSHIP: SECTIONi ❑ Driveway b(.p 1/4: 1/4I/4. y permits <br /> ADDRESS: % (state,county,town) <br /> 2 C(5/ C' " ESC Gu T Dg . ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCIVLOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> /� )� , (1---(2 i), <br /> t i c ❑Zoning District <br /> ❑This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NJMBER: ❑ Rural Address <br /> ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER.t:IF 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 and above grade decks or porches) <br /> ❑ l*f si "11 c4'ritr€n It <br /> BASEMENT: 1ST FLOOR: � <br /> .CJ =_, 3 v 3 P j TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> e, <br /> 2ND FLOOR: '+ 3RD FLOOR: <br /> filling/access) <br /> 3Y /, 3L. <br /> Ci Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round td near st dollar) $ (98 ,c.,...„..,0 <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 proje t and are they in agreement? 7Yes ❑No <br /> 4. Has there been a zoning permit issued for this pro erty in the past 5 years? ❑Yes j•iQo <br /> 5. Is this project associated with a rezone/CUP/varian e (petition/appeal# ) (leave blank if none) <br /> XJ N <br /> 6. Is a location survey required? (see reverse) ❑Yes o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes JNo <br /> [ <br /> '71 7- APPLICATION(Continue on Back)MU BE SIGNED <br /> ST <br /> 545-112(4/08) V <br /> ../rio, 0 v <br />