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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 /> J-0 L 4 Mot Sc 4 G..,c s.r ❑ Zoning tus; CUP; <br /> OWNER ADDRESS (Number,Street,City, tate,Zip) <br /> Dee estriction; CSM <br /> 3 5 ' 8„.,„f <br /> Tar ance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (cat-7y-SCL5 69i - 7 7 a 3 Sie Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Sq rk/e 0,S 4 50 -e S r el s .7- 5P V "9 Si Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE ❑ Site Pla proval from <br /> ppl• le township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us!') ❑ Elevation of PARENT PARCEL NUMBER: CURRENTZONI o property <br /> ACREAGE: P P rty <br /> ❑ PARCEL / `1 frontage drawn to scale. <br /> NUMBER b25/•0-)/Z,,O(Q(r-9Sar--Z A-Z 44 y Ac <br /> TOWNSHIP: /� _ SECTION: _� <br /> bqe ) i4,t' lJ 3 6 1/a: 5/ 141/x: 14' ❑ Drive permits <br /> ADDRESS: (St ,county,town) <br /> 13 5c/ 13 r o e kJ ❑ Sanita rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (p private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 2 Z X a o - W odd 5-h ed i� oning District <br /> This project is a new building or structure. Permitted Use? <br /> ❑This project is an additio alteration to an existing building or structure. r-� <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural °'' : s <br /> ❑SEWER SEPTIC (ne exiStl ') <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> t 1 1 �1` I ❑ we .r •odpiain/ <br /> AREA TO NEAREST SQUARE FOOT: orelanf (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: D Erosi petT it <br /> i 70 1 TOTAL SQUARE FOOTAGE: (s a disturb __ue, <br /> `T 6 �7 '1 j ' <br /> 2ND FLOOR: 3RD FLOOR: f ;pi � <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ Q and available options. <br /> (Please round to nearest dollar) $ 3000 . d U <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 3No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? UYes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑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 lallo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes l No <br /> e—_—__44. (S),2 , <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) • —► —► <br />