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v C\ nA ' , . Uwe LTA- gctevr $irk , c.2Z <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU TOMER TO PROVIDE <br /> OWNER �r/ <br /> aC Zoning Status; CUP; <br /> OWNER ADDRESS (Number, treet,City SJ,Zi• '��� J Died Restriction; CSM w <br /> 3X02 9 c y /(/ �z�,� / 5-?7/2T Variance(# )r <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS •/p S a- / f 4. Site Plan drawn o scale <br /> AGENT INFORMATION CONTRACTOR 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) l "Setbacks <br /> PHONE PHONE ite Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> FI r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Lf Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> PARCEL O/b 33 9/�a5 / 7 frontage drawn to scale. <br /> NUMBER D 7 C bb l/J (/ <br /> TOWNSHIP: SECTION: <br /> z)P t e. 35-g-1 O1E1/4: yS V 1/41/4: riveway permits <br /> (state,county,town) <br /> ADDRESS: �/362 / G ti r anitary permits <br /> CSM: / c . L SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW•PROJECT DESC T ION: /�y.) t ' t <br /> ce t7US e ontng District <br /> . MTh's 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: `RuraiAdd s <br /> � x <br /> (ne / xis o <br /> ❑SEW��V//1,74 IC w r <br /> HEIGHT IN FEET: r� <br /> `� NUMBER OF STORIES: (Not including basement) <br /> W u/i /I/ 1 / Q Wetland/Flood j I / <br /> Shorelaf d r ac went <br /> AREA TEAREST SQUARE FOOT: �, <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ' ' a_C, <br /> t'®stons✓ontra�'�ermtt <br /> BASEMENT: 1ST FLOOR: fr � r� e <br /> TOTAL SQUARE FOOTAGE: slo ear , <br /> 3®.t l/0 `Milting/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 35D0 D Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: $ O and available options <br /> (Please round to nearest dollar) -"∎ '∎ --► --► �,t ©i 0� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes AtXNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes iii No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? tit Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes allo <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 1No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes EtNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —I. —► <br /> 545-112(4/08) <br />