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„ Z9 VP0 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 1.A '‘.1......_11,v)a� y CN,-,4.. C-e„a-c HAS aZoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> S 5 (-"`c- CL. . _',,,-(t ” Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Cst"< ) Lt 3'1°0 5eSite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME ! <br /> rs�Y L /.3��. Ic i,n5 y I C( Site Plan including location <br /> AGENT ADDRESS CONTf=tACTOFykDDRESS of well/se tic <br /> /(/ ,R %4vI ��/ <br /> (City,State,Zip) (City,Stat-ef Zip) .,n l�J Setbacks <br /> 4 e1- Cis, . v.'1 / Vb57 <br /> PHONE PHONE 'ite Plan approval from <br /> 70 o S 2 j, L(`/3 y applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levatlon of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> D PARCEL NUMBER 0 S I �1y �o\� frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> c \\\b'. a� '/4: 'E 141/4: s Alliriveway permits <br /> ADDRESS: / (state,county,town) <br /> /� 0 t/A f "�. 5 S / L. Q1� r,.-+ri, �1 L!dn,1 v r0 Sanitar,T r�'If"'1 0 A <br /> per I <br /> CSM: LOT SUBDI ISION ��,d� ^ <br /> BLOCK/LOT � <br /> (public,private) <br /> C cJo 'v C.' • I, l <br /> PROPOSED PROJECT INFORMATION — STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> F e ���fi V oning District <br /> ❑This project is a new building or structure. ( ermitted Use? <br /> —This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: a Rural ` .J4'- <br /> ❑SEWER SEPTIC e.(- 41- (fide, (. (new/ • <br /> mr- <br /> HEIGHT IN FEET: ) NUMBER OF STORIES: (Not including basement) ON/ etlandinoodplam/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST ST FLOOR: <br /> SltfflGCllltrt �, <br /> 0 4, TOTAL SQUARE FOOTAGE: j, (slopes,disturt e,: <br /> flling/aceess). <br /> 2ND FLOOR: 3RD FLOOR: w <br /> (/ iew Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ -∎ ♦ ♦ -∎ ♦ ei c• " and available options. <br /> (Please round to nearest dollar) S(j J <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes % No �,,'1 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes\'-'Y No ->:.J 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 lank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes No ❑Don't know <br /> 7. Is this to correct a violation? ,tc Yes ❑No <br /> k _,_ <br /> i. c.nOVIC\-: ' \N■.,,,Cls-- - <br /> APPLICATION MUST BE SIGNED <br /> - )/545-112(4/08) (Continue on Back) -► <br /> 4 h0 , / I, <br />