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. vi 5 , <br /> 1 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME 'D lam n,�+�• Z k <br /> I [Zoning Status;CU'• ,_ / <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Rest • do V <br /> 2:115 0 w P (Jtot7t/1� �- OVeb, �1 3W1'1- Variance(# 65 • <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS 1' `- <br /> 11)2.4187 , - �k (,t e- e- tI•U ' Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimension- <br /> AGENT NAME CONTRACTOR NAME _ —� <br /> §a WVj 111 Site Plan including location V <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> r�� 4 <br /> (City,State,Zp) (City,State,Zip) am Setbacks <br /> .:. <br /> PHONE PHONE 1V Sit- an approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ET-Floor plans to scale _ <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi-us/) I <br /> PARENT PARCEL NUMBER: #1-16 CURRENT ZONING' ACREAGE: Elevation of property <br /> Q NUMBER 040709 315 2,94tiH al. $' $I •. _ -_ _ - • • .le. f <br /> TOWNSHIP: SECTION: i ,-,.( <br /> 5�✓t►�t�l0�l-t, l39 '/,: SVJ '/4'/a: �ib LdJ Driveway permits V <br /> ADDRESS: (state,county,town) <br /> X7)-(4 £T --4 7 I' <br /> Sanitary permits <br /> csM( 5(4 3 LOT SUBDIVISION BLOCK/LOT (public,private) <br /> • PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: • • <br /> 5L►�g LI M1ky iltsl(�PM' A` ❑ Zoning District <br /> INThis project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: C, !�Q� ❑ Rural Address <br /> EWER oEPTIC 520 3 V O (new/existing) <br /> HEIGHT IN FEET: ( D-- ( NUMBER OF STORIES: (Not including basement) <br /> '� e (q k `J I ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: ST FLOOR: r <br /> %Mf r' /� _319_ giO�C j TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 7 O 666___ filling/access) <br /> 2ND FLOOR: 3RD FLOOR: J 32 <br /> �1 `� ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ n dr 60Q and available options. <br /> (Please round to nearest dollar <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes to ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? es o Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es o Q <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes o <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) Res alo ['Don't know <br /> 7. Is this to correct a violation? es to <br /> APPLICATION MUST BE SIGNED <br /> 545-112 cal (Continue on Back) <br />