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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> ' , PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNE6 NAME (� <br /> 1J1\le , ` , o,e s ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> `-i%`-lD Tower L i ne.re. (Z8 C (S` �1' W W i 53539 Deed Restriction;CSM <br /> Variance(# <br /> ), <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> boS-IQSS -3((-1M LDV J` ,8 tor? ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT ME C NTRACTO NAME <br /> J \e \\cedes onook) LiAmiser/Cons4k. ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> t-\ ) Tower Line <br /> (City,State,Zi ) (City,State,e ❑Setbacks <br /> P1arsait,U3\ 53555 C.�rkk idge)col 535x3 <br /> PHONE ) PHONE ❑Site Plan approval from <br /> (.D08 i 55-3' c 3 (DVp i 1�1 - 5gac�1 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: ACR <br /> ❑PARCEL /`�/�'D'25 3DGM!9 F -\ (EX 6.� frontage drawn to scale. <br /> NUMBER Cl� 6if,J ,Jp�JC�J®( u [ /� ° r <br /> TOWNSHIP: SECTIO : <br /> hct 35 %: N 1/41/4: I D E ❑Driveway permits <br /> A DRESS`: (state,county,town) <br /> C LOAD Tower Line �BDIVia rsiAII I eLO 31`ors ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PR iECT('D SCRaION r CA.m4 to Pole & id(- LI Zoning District <br /> . ��.This project is a new building or structure. 1 ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: LI Rural Address <br /> EWER MEPTIC (new/existing) <br /> HEIGHT IN FEET: nte NUMBER O STORIES: (Not including basement) <br /> ID i LI Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1STFLOO ' ❑ ErosionControl permit <br /> }�Y + TOTAL SQUARE FOOTAGE: ,` (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: 15� filling/access) <br /> SLA 070 LI Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: $ �O 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? ❑Yes 1.4 o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? .®Yes Crlo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Wes ❑f\lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes "lo <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 • o Don't know <br /> 7. Is this to correct a violation? [Yes tvj o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545112(8/09) <br />