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• <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAMED %� /,I/ <br /> A/ 6 U✓ 5 El Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> ,'27,5" /-1/ ffivY Aim ) ©n /v f WI 5;S 7.0 Variance(# ) <br /> HOME PHONE 1 CELL PHONE E-MAIL ADDRESS <br /> 635- i [Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> k' I fel/ ,e-- 513 ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 33 -/t / 6140E-tea <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> MIV4/C /Vi ti// 5� 2 <br /> PH PHONE Site Plan approval from <br /> S7/ • 9'72,2, applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ...Al A ` .4 : / ` "Cr Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> M PARCEL'ARENT PARCEL NUMBER: p r7 CURRENT ZONING: ACREAGE: <br /> NUMBER ©(U/r2I g- 1 !N" A--1( ) .1 , C.3 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> b U,NN 'A: '/4'A: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> cs �� Wt-lie-LOT��O} Ssl WI I 5 5 SK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> -7—b '4 )( /4/.2:1 rEite .06.0C A, 2/7/ y/ ❑ Zoning District <br /> . ❑This project is a new building or structure. <br /> ❑ Permitted Use? <br /> lIf'fhis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER rvEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER 0 STORIES: (Not including basement) <br /> /514' AV�}s ❑ Wetland/F000dplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: r-, ErosionControl permit <br /> TOTAL SQUARE FOOTAGE: ,` (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 0' ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ -i ♦ ♦ $ and available options. <br /> (Please round to nearest dollar) �V <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Elves ❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Elves alo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? piles Dlo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies J(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) Dies L1j ['Don't know <br /> 7. Is this to correct a violation? ❑Yes Flo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -+ -i <br /> 545-112(8/09) <br />