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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ., 1 A <br /> • E 1 t JUG ( G MPAl t'E Zoning Status; CUP; -/ <br /> OWNER ADDRESS (Number,Street,City,State,Zip)TP t t S� P � <br /> Deed Restriction; CSM <br /> (3 t ' � Variance (# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> .406'335:2360 krSite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> �Gf�u Imq . TC,P bvi Id C—Q,$ ZrSite Plan including location <br /> AGENT AD RESS CONTRACTOR ADDRESS of well/septic <br /> z 95( 4gm,1-$1. v1 245( 44444I . 0 R s <br /> (Ci ,State Zip) 0 (City,State, ' ) l Setbacks <br /> w, Prairic w l 53516 S tan ?rai■ r'e. , WI 5 S3 Sib <br /> PHONE ( cat) ,Site Plan approval from A /A <br /> 1 .420e -211. - 67341 t car) 1 '64-037- t'/i0 Z applicable township. /d' <br /> E-MAILADDRESS E-MAIL ADDRESS / <br /> b-a►4! vva eiwi C ,1I'bLvt '� mod wa -4e w�t�blue•vier " Floor plans to scale <br /> PROPERTY/LOCPA�TIOLN INFORMATION (http://accessdane.co.dane.wi.us/) l!d Elevation of property <br /> PARENT D PARCEL //CC�/NUMBER:3,_ U/1? t._ uRR ZONING: ACREAGE:, frontage drawn to scale. <br /> NUMBER (f/ 'O J J(•J/ I <br /> TOWNSHIP: SECT <br /> 1312.4 SID L __ 3/4: 14) 1/41/4: S kil Driveway permit H/A- <br /> ADDRESS: <br /> (s ate, county own <br /> / / L U Y v.-A b k r( .�t�� <br /> Sanitary permits ' c 3 �3 <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, private) <br /> 4-3 KA►ifwue- wni.n <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: // / Dec, I <br /> e-�,�/ 51001G FOAM,L LANs_ / b x) IJec-f- {Y Zoning District -1 <br /> I ,J' <br /> This project is a new building or structure. +Permitted Use?1 f)( <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Z I Address /� I <br /> ❑SEWER SEPTIC S 2 G 3 , 3 0/existing) !� d <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) Lel y <br /> Z. 3 I 0 W loodplain/ L h <br /> horeland ttachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garra�►ges and above grade decks or porches) <br /> BASEMENT: 31 1ST FLOOR:' 1111"I� ErosionControl permit <br /> 11 2 4, TOTAL SQUARE FOOTAGE: y (slopes, disturbance, <br /> 2ND FLOOR: �A 3RD FLO; filling/access) <br /> iv) <br /> 1■ bZ <br /> ,Review Location Survey 1' <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -� -► ♦ �Gj/ h�/�a- and available options. h <br /> (Please round to nearest dollar) I (/l/C/ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes LONo 1:1 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yt LiSNo ❑Don't know <br /> I <br /> 3. Have you talked with the township about your project and are they in agreement? 0 Yes U NN <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes l.'lNo <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) (leave blank if e) <br /> 6. Is a location survey required? (see reverse) ❑Yes No ❑Don't know <br /> 7. Is this to correct a violation? ,, ---- ..(.I..Mt ❑Yes ❑No <br /> I <br /> 3 9 2, t O) APPLICATION MUST BE SIGNED <br /> i545-112(4/08) (Continue on Back) —, - -÷ <br />