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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER N E > <br /> nil e/2/06, 4- (icC:Mt e j\JE-1 `J0/) ❑Zoning Status; CUP; <br /> OWNER ADDRESS umber eet,City,Statp,Zip) Deed Restriction; CSM <br /> 43 / 64, Q c.�h 4 Lt [�c , i7' 'O�i u4hio 1))k)s 5 3 S F�`1 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ei: V 3`50?/ 40©8 a0-- 0- IL/.(I •�5✓40Z ( M ❑Site Plan drawn to scale <br /> AGENT INFORMATION I 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) ❑Setbacks <br /> PHONE PHONE ❑Site 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/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER 0510-I 31-q 1 91-0 A'1Mc frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> u--I-L 0 D y4: ihyt: ❑ Driveway permits <br /> ADDRESS: (state, county,town) <br /> I'i(y Co U n 4 -� 6*. u9h40it 1 w s�c5`7 p Sanitary permits <br /> CSM: L SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 6 iL Rf ' C J k RC F 17 K 1 ❑ Zoning District <br /> . ['This project is a new building or structure. LI Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER ' EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> 1 a F� Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ <br /> ErosionControl permit <br /> - 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> `)c'�' Cr'' , s-� • ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -► ♦ -► ♦ c t%D • • and available options. <br /> (Please round to nearest dollar) $ 6 5� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes gi■o ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ Yes O <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes [Rio <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) rives ( o ['Don't know <br /> 7. Is this to correct a violation? Des :1 o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) - <br /> 545-112(4/08) <br />