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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 /> Cccjn}`f o -P- > n't Parks C o I v\h I“ i 0( ❑pntus; p;OWNER ADDRESS (Number,Street,City,State,Zip) Restriction; CSM <br /> 1 N Oc.IK Ci c) IJ Ir I'l5 11J.so1\, c . i 53'71 f3 nce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> r.\--- Sod, 1 "d s (5,N oc4ior\ Co,, r„c, ❑ Site Plan • ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS septic <br /> 190 A, E, C. uo.x 9 'i 4{,p1e.yt.�!-e R . <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> Mo,c);Sc�, i„,)-1 53'713 l isdn, w= 53'-7I3 <br /> PHONE a q -act I9 PHONE ❑ Site Plan a oval from <br /> GO e- 60g_ a )/ _ cj ,o applic etownship. <br /> E-MAIL ADDRE S E-MAIL ADDRESS <br /> �r�h.c se,,b S c.- at ti c&c)ckniti s co • coM <br /> !_. _ iz c,o,xkil Q,w i .u ❑ F oor s to scale <br /> PROPERTY/LOCATION INFORMATION (http:f/accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y <br /> Li PARCEL frontage drawn scale. <br /> NUMBER 06 2,1060&-3 sa-9«00-9 A= I (E x 110 <br /> TOWNSHIP: SECTION: t 1 1 ❑ Drive y permits <br /> Town o$ V�kcor c\ 3 S /a: N W %/a: $!� (st e,county,town) <br /> ADDRESS: <br /> I e a8 RWYAZ MR L ❑ Sani permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (p lic,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Pi -4- Toile's /A ping District . <br /> ®This project is a new building r structure. Permitted Use? <br /> ❑This project is an addition/ teration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural ' =• <br /> ❑SEWER SEPTIC (new -xistin' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> I a.` 1 Ll Wetlan odplain/ <br /> Sho and (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: �` <br /> ❑ EroslonCtIn glint, ,:, <br /> 8 0 �C"ta + TOTAL SQUARE FOOTAGE: j (Slope . sturb ei <br /> 'fil i ccess) <br /> 2ND FLOOR: 3RD FLOOR: <br /> }a ❑ Review catloh'SStiruey <br /> ESTIMATED CONSTRUCTION COST: --► ♦ ♦ -i -� and aitable options. <br /> (Please round to nearest dollar) $ S 5 18 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑'s N CI Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es ❑ o <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' one) <br /> 6. Is a location survey required? (see reverse) D Yes EU o ❑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 />