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ZONING PERMIT APPLICATION wwwcountyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> TOW I\) OF QUN►J — AT CA Y R-6661-‘066& ❑ Zoning Status;CUP; <br /> OWNERADDRESS (Number,Street,C State,Tom) Deed Restriction;CSM <br /> LTt C Uri c? 51 4( i k jck <br /> ) v1/4)," 53%S Variance(# ) <br /> HOME PHONE E-MAIL ADDRESS <br /> p08 2%- a • t D� <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME �p, <br /> 1J EWGQrg('. CO i\�`71r"—V,0 ) ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 16(91 o RA,e_ De..1 .■)1 fE2Co <br /> ❑ Setbacks <br /> ���.�) ( .smta.zip) � �3171�1 <br /> �I , <br /> PHONE 1:1 Site Plan approval from <br /> ((r X333_.S 220 applicable township. <br /> E-MAIL ADDRESS ADDRESS ❑ Floor plans to scale <br /> i ( VIILLOCO .b .45- <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevationofproperty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ Nut CA00/0- L(D2 • ')D00-3 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> fit)it OF DO Ot\ a b 1/4: N vJ 1/41/4: ❑ Driveway permits <br /> (state,county,town) <br /> ADDRESS: <br /> r \l Imo) F L tTS m ve)1 LE fOM C f'fW r litQ 51 4 aloe 4.a 1-N. ❑ Sanitary permits <br /> LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: GQM1/4)RtA L3 E�n c--^^ (T,�n Zoning�r ! �[_. ZOni District <br /> . 121This 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 NUMBER: ❑ Rural Address <br /> ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetiand/Floodplain/ <br /> M I�) •�' �tc, ,- (o-0'1 A.F•F. 1 � b Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ Erosioncontroi permit <br /> BASEMENT: 1ST FLOOR disturbance, <br /> N/� 3 15go ''5� +, TOTAL SQUARE FOOTAGE: + filling/access)s <br /> 2ND FLOOR:qic 3RD FLOOR: <br /> 0/A- ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -• ♦ -• pp and available options. <br /> (Please round to nearest dollar) 6 1 c a <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 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 blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPUCATION MUST BE SIGNED <br /> (Continue on Back) ■ -► <br /> 545112(4re8) <br />