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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> O)NER NAME / <br /> IJwe t tit Af'r'o ❑ Zoning Status;CUP; <br /> OWNER <br /> ADDRESS (NN b Street,City,StatVi� <br /> Deed Restriction; CSM <br /> y y a F y f r ( iD t / � <br /> , _ Variance(# <br /> ) <br /> HOME PHONE CELL PHONE E-MAIL ©DRESS <br /> • 13 356a <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> NT NAMEr CON7f TOR NAME <br /> .vv) t C&L,t.V\ Qt evi. e ❑ Site Plan including location <br /> AGENT ADDRE S (� CONTRACTOR ADDRESS of well/septic <br /> f3fa SfkrrScLod 0,r, <br /> (Citye Zip) i (City,State,Zip) <br /> ❑ Setbacks <br /> H �Ul <br /> P PHONE ❑ Site Plan approval from <br /> �j�8 NE 3 86 5 applicable township. <br /> E-MAIL rADD RES € /S N , �o � E-MAILAODRESS <br /> 51+55151+511' S / <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CUREN,, ZONING: ACREAGE: ❑ Elevation of property <br /> /4—❑ PARCEL „ _ C &X frontage drawn to scale. <br /> NUMBER <br /> TOW HIP: SECTI N: <br /> n A 174. '/a'/a: iI 6 ❑ Driveway permits <br /> (state,county,town) <br /> ADDRESS: �J J <br /> I tf t a P``k°'ue y �"" Pic �`e 'k� ' Le, ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF] [ sf <br /> PROJECT DESCRIPT N: r_ ` r 0 41ga <br /> Nett. -L k mh ca e,S L td kb wt P L Zoning District 9 <br /> . ❑This project is a new building or structure. ❑:Permitted Use? <br /> p_This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER ❑SEPTIC N,(neVV/existlntg) : N <br /> HEIGHT IN FEET: ) NUMBER OF STORIES: (Not including basement) <br /> k) ❑'Vt etland/Flodd0Aiti <br /> I AREA TO NEAREST SQUARE FOOT: ShOreCartd (&ttChmtt)F <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1 ST FLOOR: Eroskortyprnr-cotipermltr <br /> lg2 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbance e <br /> fill►tngfaccess) <br /> 2ND FLOOR: 3RD FLOOR: ^ / <br /> O�1 yr■ ❑ R'evlew li_ocat.03*0 rvey '_ <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ /7/� Oa and available options <br /> (Please round to nearest dollar) $ ‘ 5 w• . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ceiNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes tifNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? I Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? I 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 ❑No 40 Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> 13 <br /> S� APPLICATION MUST BE SIGNED <br /> �t ,d (Continue on Back) ♦ -► -► <br /> 545-112(4/08) '] <br />