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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> • <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME �'' <br /> -)?i �U'�M°6'f 1C Zoning Status;CUP; Il.�1( <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ) // `` <br /> 5-Y/6 k't c'`c- EI' �Ae�aj1/ W)• 5355/ Deed Restriction;CSM ,t h <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Variance(# ) 2 Q S 7 <br /> 60-4gs4-3 rt ,g Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME/ <br /> Sb Z1 ,/ LC-e,,q e,e Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2..7 1 ritLe St AO, 7 1 <br /> (City,State,Zip) (City,State,Zip) f Ai Setbacks ‘,/,?///310AZT <br /> PHONE V�"��74'/)7��/s S3cS� <br /> PHONE Site Plan approval from <br /> j 6 D i- 6 S 3 65-6 applicable township. ni E-MAIL ADDRESS E-MAIL ADDRESS A/Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT P L NUMB CURREN ZONIN ACREAGE: g levation of property <br /> PARCEL I�v' L—#2— 923 <br /> NUMBER VVVV -- � itX ��7 frontage drawn to scale. <br /> TOWNSHIP: J SECTION: /�/'U/ iv 4/A_ <br /> e�I N if ' : �'V V44: S iy riveway permi <br /> ADDRESS: (state,coun , own <br /> 59/6 ' ia �d t Sanitary ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (publicre) � 2.4 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: A — �A� <br /> y sei-ov Poo AL, gZoning District a <br /> ❑This project is a new building or structure. <br /> KPermitted Use? Ai' 7 b <br /> ®This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ;'tJ Rural ' ••.--- S f)C <br /> EWER [EPTIC /\(new/stin• <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> /, / 0.1�Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shorela •li ent) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)t-�"m"- <br /> BASEMENT: 1ST FLOOR: 'Cm Erosion on ro permit <br /> ? 0 + TOTAL SQUARE FOOTAG : + (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> ...'&././ 0.0 <br /> n Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> o A..._ <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ "■ ;5' �+'�, /f9 P <br /> 1. The property <br /> 41111111111111111...—In 300 feet of a stream : 1000 feet from a pond or lake? QYes ao ['Don't know <br /> 2. Is there a wetland or floo•p atn on or near the property? f jYes No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Efres QNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes EN <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appe. 0 (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ` • es ao ODon't know <br /> 7. Is this to correct a violation? ill es alo <br /> CAPPLICATION MUST BE SIGNED <br /> 545-112(4/06) (Continue on Back) ■ -■ <br />