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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> 'PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME j, <br /> \-�itr L kae, htkl)r-ec� Zoning Status; CUP; '� <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> t8€c l ttl3r Ln �d I S- S�� Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> �(, ��'y" 5�b i►� Site Plan drawn to scale <br /> 'GENT INFORMATION CONTRACTOR INFORMATION and includes dimension- APL <br /> .-ENT NAME CONTRACTOR NAME <br /> EN ite Plan including locatio/ 0 0� <br /> A rAODRESS CONTRACTOR ADDRESS of well/septic l(� <br /> (City,State,Zip) (City,State,Zip) ON Setbacks ( 3)3 0 0 /D <br /> PHONE c„„._, PHONE Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADIDRESS <br /> gi Floor plans to scale <br /> 1` :, /� <br /> FP.;y.�E4TY/LOCA'�EON INFORMATION (http://accessdane.co.dane.wi.us/) �Elevatlon of property <br /> PARENT PARCEL NUMBER: CURRENT ONI G: ACRE <br /> [PARCEL ,/ 7/r_.Z --g/S'2 , /� - � g, frontage drawn to scale. <br /> NUMBER ' 1 r , <br /> TOWNSHIP: r (( SECTIO d ?' T �” 1� Z5 '/a: %%: S c ,:� Driveway permit <br /> ADDRESS: (state, county, o n <br /> CSM: LOT SUBDIVISION BLOCK/LOT /rte/ Sanitary permits <br /> — (public, lap <br /> PROPOSED PROJECT INFORMATION ';STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> �$ t � 6 v. a /^�r^Q ti. Zoning District / -: <br /> . ❑This project is a new• •.ng or structure. FA' Permitted Use? 6 4..„-- <br /> ,�r4This project is an :dditi.• -Iteration to an existing building or structure. <br /> lAd <br /> SANITARY SERVICE: PERMIT NUMBER: Rura <br /> • - <br /> {)EWER :VI-EPTIC .0qW/- <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not of including basement) <br /> "Z 11 W Ioodplain/. -: <br /> AREA TO NEAREST SQUARE FOOT: ho>e an. .(attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ErosionControf permit <br /> BASEMENT: 1ST FLOOR: <br /> ` j TOTAL SQUARE FOOTAGE: ,,, sla es disturbance, <br /> ( t <br /> fillinglaccess) <br /> 2ND FLOOR: 3RD FLOOR: / 50 _ / <br /> 7 Review LocationSurvey <br /> ESTIMATED CONSTRUCTION _o. ' ,COST: $ ; <br /> 000 a and available options, .,. ,i <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 [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? Elves [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 /> APPLICATION T BE SIGNED <br /> (Continue on BackMUS) —► -+ —► <br /> 545-112(4/08) <br />