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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 /> La- V ( S Q A R ( 0 c,✓ ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction;CSM <br /> , L/ 7G pi, D L H 9 / X F C k 6go lie v i c. 1 C„ (00 0 0 7 variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ILO q 5 C 3 0 Y3 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> SA /'I E 4 S • w ,✓ f R 5 4/ E 45 o w, ce /1 ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: El <br /> 0 PARCEL S/2 .3 1-66-7o -co •#<- 3 . 2 7 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 4 L 6 !6/' 3 4- %: ,v E '/41/4: /G F 0 Driveway permits <br /> ADDRESS: (state,county,town) <br /> 1 g ae4co 4tie F . G /_' R > OA- � ( g- ,353 Y <br /> CSM: LOT SUBDIVISION BLOCIVLOT ❑Sanitary permits <br /> D /C U ix e d 9 2 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJEC T DESCRIPTION:' .1 C / F R a, 7 "4" If( 4 a /I X y d �' ❑ Zoning District <br /> . OThis project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure4€F4 Ace Air•7 <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER E)EPTIC (new/existing) <br /> HEIGHT IN FE T: NUMBER OF STORIES: (Not induding basement) <br /> 11 0 ❑ We tland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1 ST FLOOR: ❑ ErosionControl permit <br /> j TOTAL SQUARE FOOTAGE: +, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 30 = ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -► ♦ ♦ o and available options. <br /> (Please round to nearest dollar) $ / 2 0, 00 <br /> , <br /> B/r <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes Ilo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? E Yes opo DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? IYes alo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ®Yes OW <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 pg o 00on't know <br /> 7. Is this to correct a violation? [JYes T o <br /> APPUCATION MUST BE SIGNED <br /> (Continue on Back) ■ —► -+ <br /> 545-112(4/08) <br />