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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME A �' <br /> {�oland 1a. Sco- Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ����CCCC <br /> 2351 C M .. -Iszyec. ,W' 53572 Variance Restriction;CSM <br /> � Variance(# ) <br /> HOME PHONE CiELL PHONE E-MAIL ADDRESS <br /> roland-Sco44 Q•y,.,.th l-cow Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions / /© <br /> AGENT NAME CONTRACTOR NAME �/1 <br /> Todd Se`I I e r 1:1 Site Plan including locatio <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2937 &raeal Ave ;� <br /> (City,State,Zip) (City,State,Zip) 3"1 Setbacks 7S/23/1/2/2-5/ <br /> taiUtz Mounds w1 53S17 <br /> PHONE PHONE ) OSite Plan approval from // <br /> (nob 2251`194 applicable township. A ^/ <br /> E-MAIL ADDRESS E-MAIL ADDRESS /�t- <br /> .4dd, .Seilere3yria l l-c_o✓rt ►a Floor plans to scale `I <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property I <br /> ®PARCEL / �t p /t r - $Ry4 K t frontage drawn to scale. <br /> NUMBER do06-7-21-9160-� A-I c 32A,boo SK <br /> TOWNSHIP: SECTION: <br /> 131 u¢. MouvldS P2. 1/4: sW '/1/.: NW gDrivew- •-rmitl_,, <br /> ADDRESS: (stat- coon town) <br /> A$59 (to £ h 14 Noyeb t 1.1I 53512 Sanitary •- •-• <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> b45 1`I I (publi• p ate <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> P JECT DE CR IO t ,Q <br /> Cv v w. r2b GCYL / �- - d 0 yl 14 ©b a V /`t`N gi Zoning District A �J l�( <br /> . This project is a new building or structure. / / Permitted Use? ,-OIGT t^ <br /> ®This project is an addition/alteration to an existing building or structure. /� <br /> SANITARY SERVICE: PERMIT NUMBER: /L1.Rural A A. - �. <br /> EWER [4EPTIC (new/'Lid 110 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 2313 t 1 iu We t lo••pal.o <br /> (rahcti) • <br /> . = : chment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches). <br /> BASEMENT: 1ST FLOOR: ErosionControl permit <br /> 528 O 64.0-° j TOTAL SQUARE FOOTAGE: 4 slopes,disturbance, <br /> LC9 filling/access)s, -2©t'6 — 0 <br /> 2ND FLOOR: 3RD FLOOR: <br /> I 0(28 `D 0 Location Survey ( (/c <br /> y <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) '♦ "♦ "+ -0 -∎ '♦ $ 8• %�!: .lei d available options. <br /> /3./,0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a •and or lake? 12 . o ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? .... ► es o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement?.... Rees Vo <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 Bo ['Don't know <br /> 7. Is this to correct a violation? QYes o <br /> 6C P ` /i C _ 2_ 01 f — O 00 l 3 APPLICATION MUST BE SIGNED <br /> J (Continue on Back) ■ -♦ -∎ <br /> 545-112(4/08) <br />