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ZONING PERMIT APPLICATION uvww.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME_ <br /> I 1I'1IS VI v 19 1 Mc L ou Zoning Status; CUP; A ....../ <br /> OWNW'ADDRESS (Number,Street,MCity,Stet ip) Deed Restriction; CSM <br /> HOME PHONE 1 r CELL -1-- I60 1�MJ W, 55402, Variance(# ) <br /> E-MAIL ADDRESS <br /> 1%-312.D du Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME ' TRA Ts-NAME ^D <br /> Itiilil.' 11![J 0 i D-Ac CO�\ owe_ # C] £A ital' Site - . - • .•'ng locati t/ <br /> AGENT ADDR S CONTRA TOR ADDRESS of -II/septa <br /> 110 PA(i 3 VYY1 (2-et 410 <br /> tr'0 U i �(Ci ,State,Zip) City,State,Zip) Setbacks 63/ 0/1-577 tads \i 5 I1 fe. IANA S,W i <br /> �J511 <br /> PHONE PHONE gsite Plan approval from 5j} <br /> , 443"1 (pj Q'1 4 -1 Cvl j1 applicable township _ <br /> MAI�ADDRES E-MAIL ADDRESS i 0j, eV SS <br /> / <br /> D lap rreri (Y OFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: fi;0;; CURREN Z NING: ACREAGE: ^ 1 Elevation of property <br /> ❑NUMBER �1Cfr"ao3"'5536- — 1 2, 2_/ frontage drawn to scal <br /> TOWNSHIP: pp SECTION: <br /> V\‘ t <br /> ltdle Y1 '/a: 14\i‘j '/'/4: 9 / 0-Driveway per ' -_ <br /> ADDRESS: ((state, count ow. <br /> CSM: ��� Lo Y� SUBDIVISION BLOCK/LOT�Z <br /> 4--sanitary s <br /> rY��per- t <br /> 0:1coZ 3 (public <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESC PTION: Co / <br /> on j G11 -h un 10 / 6 ' Zoning District 4 -1 <br /> ['This project is a new building or structure. D : ; h. q�� �, -ermitted Use? �� k �O N S <br /> "his project is an addition/alteration to an existing building or structurel 4 L c/ <br /> SANITARY SERVICE: PERMITt')UMBER: •�. - s <br /> EWER APSEPTIC /"0 k,SC'+.(.A<Rural <br /> (new/ ".) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1 Wetland/Floodplain/ I <br /> AREA TO NEAREST SOUA E FOOT: Shoreland (attachment) N/A_ <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) gid FrosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> i 2,0 1 + TOTAL SQUARE FOOTAGE: y (slopes,disturbance, / // <br /> 2ND FLOOR: 3RD FLOOR: filling/access) Opp , <br /> 1 2.0 XReview Location Survey AI <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ,► ♦ .s and available options. •;,�. <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 ISINo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes IZINo ❑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) h [Yes No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> 5-7i ©n APPLICATION MUST BE SIGNED <br /> (Continue on Back) —■ —► <br /> 545-112(4/08) <br />