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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> • <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Coo -Vy . D i' e -Parks ComMiSSion ❑ Zoning Sta#Ls ;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 1 r EN Oai� C,T UNIT a,3 Deed itSstriction; CSM <br /> a e /'1ar)i soc■,csi I S 3 T7 18 rt ce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME n CONTRACTOR NAME <br /> �c) (\ Sc,1�-Avt (A 0. C 1 InR_ Do niels (01,5fruc-4io/ Co,/ Inc. ❑ Site PI including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of w /septic <br /> ‘,q 1 A,E. C. (..,),, y 9 i9 A-pple�.,,it R d , <br /> (City,State,Zip) (City,State,Zip) CiSetbacks <br /> Mckkor\ w z S 3 9 l 3 tA0,61`scA, WI 5 3 r713 <br /> PHONE PHONE ❑ Site Plan proval from <br /> E,C - d,66 - 4 '19 g coe —a'?/ — lit9C0 applic let nship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> GhI`o1/45,AluA-•• 1 0 cn,do,f\t.w I ,U S 00.1 Ke�al\telS CO.1oM ❑ oor ans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of ro ert <br /> PARENT PARCEL NUMBER: • — CURRENT ZONING: ACREAGE: P P Y <br /> ❑ NUMBER 0 SIB/0811/-334- & A-I (Ex O, frontage drawn to scale. <br /> TOWNSHIP: � SECTI n/ /l)I.J <br /> 'roc.1 n vS w f\ Pte►s�e 3 1%: — '/a'/a: ' ❑ Drive ay permits <br /> ADDRESS: (St ,county,town) <br /> Lct 11 Ccvn+Y N icshwo.y TT ❑ Sanita •ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (publi,,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJT DESCRIPTION:. � <br /> t1 j T 01 k f'oning District <br /> ®This project is a new building or structure. Zli Permitted Use? <br /> ❑This project is an addition/ eration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑'Rural'Ad•• -ss _- <br /> ❑SEWER EPTIC i, (new/ Sti a <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1`k' ( ❑ Wetlan• oodplaictl <br /> AREA TO NEAREST SQUARE FOOT: ShOr� °,,, (att t lrrtienf) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ <br /> BASEMENT 1ST FLOOR: ,J ErQSlon Y • t <br /> 0 o Ti--- TOTAL SQUARE FOOTAGE: (slopes d s- ' rban , <br /> L> illintg/a $ ss D <br /> 2ND FLOOR: 3RD FLOOR: �� ^�a '- <br /> t ❑ Review�.e ' ury <br /> ey <br /> ESTIMATED CONSTRUCTION COST: _o. ,.+ "♦ '♦ '♦ '♦ <br /> $ a5 518 V° ate fORS <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑xes ❑ ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? UYes ❑ 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 i ne) <br /> 6. Is a location survey required? (see reverse) ❑Yes ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ -- —► <br /> 545-112(4/05) <br />