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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 /> ..)e Po`f 4-eir- <br /> al/Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,S te, <br /> 3 g ?`1 rre o o f Ur, V e rD n 0. WI-J I- .r-3,5-Q 3 Deed Restriction; CSM <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS l Variance(# ) <br /> 6 Og — 7 1-37t/ C P°( e. `Mz r1.e°WI arSite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> c( <br /> Site Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE gr Slte 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/) <br /> PARENT PARCEL UMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ NUMBER ©38/o 7 D '-2Oa-602f6-0 IT - l , 15703- frontage drawn to scale. <br /> TOWNSHIP: f i0i iti p! ✓ SECTION: <br /> a 1/: vw '/ /: se--- I'` <br /> 1 riveway permits <br /> (state,county,town <br /> ADDRESS: ( ' ) <br /> 3M9 r/'errtDYI I [)c. VervKa bt.) - 3-33-f 3 Ø 'anitarypermits <br /> CSM: LOT SUBDIVISIQN BLOCK/LOT <br /> Sauk r�i(i`ets l (public, private) <br /> PROPOSED PROJECT INFORMATION /` i4 'STAFF,REVIEW, <br /> PROJECT DESCRIPTION: <br /> d eG cz,c re vkAr Uc -61 Z,,, . , . .., <br /> oning District <br /> . ❑This project is a new building or structure. ermitted Use??, <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural ' ed <br /> //n + <br /> ❑SEWER TIC 1-ew XI n— ,* <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) pcv, et� lark/Plood�iam -- <br /> . <br /> AREA TO NEAREST SQUARE FOOT: Sr?�reland (attachment} . <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) N`s a <br /> v rosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> 3 `, TOTAL SQUARE FOOTAGE: ,, (slopesiidisturbance, <br /> filling/access) ,2 <br /> 2ND FLOOR: 3RD FLOOR: <br /> ■ 4 <br /> ESTIMATED CONSTRUCTION COST: 11 eviev Location:Survey, <br /> -. -. -. -r oa andavailableQPilons , <br /> (Please round to nearest dollar) � Q��, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 0,No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes SiNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? 0,Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes ❑No "ZOO" -oOBc_f <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) (leave blank if none) J <br /> 6. Is a location survey required? (see reverse) ❑Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -* -► <br /> 545-112(4/08) <br />