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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER ME <br /> "e5 AL-4M.67- ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) , Deed Restriction;CSM <br /> ZD(o/ S?s'—'/A16- g.p , Variance(# ) <br /> X73PHONE CELL -Y6419 E-MAIL AD�E/�0 @ M6 ` -o' 1 ❑Site Plan drawn to scale <br /> AGENT INFORMATION 7 C/O��N/T�,RAC+T'YO'R INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑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: i CURRENT ZONING: ACREAGE -7 <br /> ❑PARCEL ��/_z'7Z—�r L,LISj G A a z i 570 frontage drawn to scale. <br /> NUMBER <br /> TO SHIP: SECTION: <br /> y,,f'Z // �r4A)(Tj 27 ,A. N w 1441A: N L ❑Driveway permits <br /> ADDRESS: <br /> ��� �'' (state,county,town) <br /> Zd l°I _J1��N� ' ' -s/ Lw' i' AI ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> i / (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESC PTION: <br /> A) <br /> 4e4 . LI Zoning District <br /> . anis project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER ,PTIC -- (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 26 ,Z7- / ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <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 /> 40 X /.� 0 12_ r�oTrAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: (O� '3RD FLOOR: <br /> filling/access) <br /> 0'0 LI Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ �� 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 ENo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Ekes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Efres No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes po <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) Ekes r No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes eNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545-112(4/08) <br />