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• ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER <br /> '" V teto d€L' k4 4-K e,A El Zoning Status; CUP; <br /> OWN ADDRE $(lumber,Street,City,State,Z ) <br /> Deed Restriction; CSM <br /> I _ 'I S H -C 9lJ 1'ADY• �� S3S Varia nce(# <br /> )HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (oCq- 3 1` <br /> v.%. ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> A NAME CONTRACTOR NAME <br /> (a lilt_ , aL in2S ❑ Site Plan including location <br /> AGENT ADDRESS.rt CONTRACTOR ADDRESS of well/septic <br /> SSt1 /1/4.)0 floe.. r`/r <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Si-Docobtoyk UT= s 3S-Vi <br /> PHONE PHONE ❑ Site Plan approval from <br /> (POSE—cD,19--1)tiO applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> c tg " • kai A . ... , , 1 �,,tom ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER 1� <br /> TOWNSHIP: SECTION: <br /> 1 1 , ❑ Driveway permits <br /> V Ind /4: /a/a: <br /> (state,county, <br /> ADDRESS: [ °( 1■�rl dot' h.g �S+C % Si ( y town) <br /> CSM: LOT SUBDIVISION � �B�BLOCK/LOT <br /> ❑ Sanitary permits <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> u, ❑ Zoning District 1 <br /> ❑This project is a new building or structure. <br /> ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address,,,, <br /> ' SEWER ❑SEPTIC (new/exiSting)��; <br /> tea::. <br /> HEIGHT IN FEET: of NUMBER OF STORIES: (Not including basement) <br /> 35 ❑ Wetland F000dplain/ , 9 <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ❑ ErOSlonContrO <br /> BASEMENT: 1ST FLOOR: l pe[mlt <br /> + TOTAL SQUARE FOOTAGE: (slopes,disturb ce de <br /> filling/access}e": a <br /> 2ND FLOOR: 3RD FLOOR: <br /> I ao , ,.., x, , <br /> L1 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ �-y� and available`Options <br /> (Please round to nearest dollar) $ 1 1 t bl J r x,..mom. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 4riNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? 14t Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes gfNo <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) CI Yes ANo CI Don't know <br /> 7. Is this to correct a violation? ❑Yes giNo <br /> APPLICATION MUST BE SIGNED <br /> Cti Back) —► —► <br /> 545-112(4/08) <br /> (Continue on ac ) ♦ <br />