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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 /> ALO&MAC Z-101.- -,0 ate^ 'Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) b <br /> 33-2 1--A-V-ES}AO 0Z. U6 ZTa3 WT eed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 030 1 � t, _...% ' <br /> ■ •, , •Car) Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site Plan ' cluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s ptic <br /> (City,State,Zip) (City,State,Zip) et acks <br /> PHONE PHONE Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION ro(http://accessdane.co.dane.wi.us/) II Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ONING: ACREAGE: p p y <br /> ❑ NUMBER or--,7) a s`I �`t.l S S 3 ^3 /L-1 rontage drawn to scale. <br /> TOWNSHIP: SECTION: / <br /> l i(� S Y4: ' ,t 1/4 Y4: W d--J Driv w permits <br /> (stet ounty,town) <br /> ADDRES. <br /> 3 0 ...s e),),, At., 'J/�� Sani - permits <br /> CSM: LOT I SUBDIVISION BLOC OT <br /> -I ' (pub'-, •rivate) <br /> PROPOSED PROJECT INFORMATION ' STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> (J � X) �onl District <br /> 2 eThis project is a new building or structure. <br /> r Ittetl Use?; <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVI E: PERMIT NUMBER: , tlraf ' •• ess„, <br /> UP SEWER ❑SEPTIC ( " PXI_,„.11:11 ka <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) Wetland/ , <br /> -y11L AREA TO NEAREST SQUARE FOOT: Shorefard aGt1Rtpn <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porch- Q Erosioneontrof pe A <br /> BASEMENT: 1ST FLOOR: o H <br /> S l TOTAL SQUARE FOOTAG • (Sfopese0sturodme, _ <br /> 2ND FLOOR: 3RD FLOOR: • Ccess) <br /> Cevfew Location Survey <br /> ESTIMATED CONSTRUCTION COST: _ _. ..+ ,.+ _o. ) and avatiabf 'bons <br /> (Please round to nearest dollar) ♦ C <br /> .AV' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? --Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? - es ❑ o ❑Don't know �''1 <br /> 3. Have you talked with the township about your project and are they in agreement'? El Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? El Yes <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 qatelo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► ■ -► <br /> 545-112(4/08) <br />