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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 /> /e)ora. c/(fit " _, Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) / Deed Restriction;CSM <br /> 7&/5 -tea/ ohi i-e /o(/z -e Variance(# ) <br /> HOME PHONE CELL PHONE l E-MAIL ADDRESS <br /> •73- 4(3/ • Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION -- and includes dimensions <br /> AGENT NAME CONTRACTOR NAME Vo <br /> /it X5'44' 4ere'ee to VEl«4- Eu'..t?F,(.!— Cu)e l ite Plan including location <br /> AGENT ADDFtESS d CONTRACTOR ADDRESS //. of well/septic <br /> (City,Stat ,Zip) (City,State,Zip) etbacks <br /> Z (l- Pt 6-3s-5--s- e e <br /> PHONE PHONE ❑ Site Plan approval from <br /> Dfi QZ oe S4 /‘ L< appl. able township. <br /> E • 'ILADDRESS E-MAIL DDRESS <br /> e 4 , O 141 A b. .(41:.' !c ` Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: a Ele n of property <br /> y <br /> ❑ 01,09- j Z-a-3ov-f A . t En <br /> NUMBER z Z 3 fro e <br /> awn to scale. <br /> TOWN IP: SECTION: <br /> / /j, e–rmits— 1/: 414: f� ( ate,county,, o )ADDES : <br /> /Q/g 71/0/i2)5' (a D/Cite intk Suk '7(Z ❑ Sa • ermits <br /> CSM: LOT / SUBDIVISION BLOCK/LOT (p lic,pn <br /> .. .- i <br /> PROPOSED PROJECT INFORMATION , STAFF.REVIEW <br /> PROJECT DESCRIPTION: <br /> / jirZoning District A. /Ex <br /> ❑This project is a new building or structure. .Permitted Use? <br /> K This project is an addition/alteration to an existing building or structure. <br /> ITARY SERVICE: PERMIT NUMBER: ,U Rural Address _ e <br /> _ ❑ SEPTIC y (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) r <br /> Z , Wetland/Floodplaln/.�v le <br /> Shoreland (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 /> ; "trgsioncontro dirt ,it--- <br /> ; - <br /> r 4, TOTAL SQUARE FOOTAGE: 4, (Slopest dlstu rk " <br /> filling/access) :00 <br /> 2ND FLOOR: 3RD FLOOR: 7‘ 0 P <br /> ESTIMATED CONSTRUCTION COST: 5.-1/ b vtewl„OCattl�tleyQ <br /> (Please round to nearest dollar) -a -0 ♦ - '' -■ $ Q v and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ' ❑Yes ��,Nom ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ..Id1' ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes .„.@lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeat.# •-)o L) (leave blank if e) <br /> 6. Is a location survey required? (see reverse) ❑Yes o Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> >�e-e APPLICATION MUST BE SIGNED <br /> (Continue on Back) -* -♦ <br /> 545-112 t4109) <br />