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l <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> J_os of 4__bt f1CSe 9 nnw f AAeie- ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) �Q�����^_��J (Air Deed Restriction; CSM <br /> HOME PHONE SrQ& LL (4 LA E-MAIL (A 5 3576 Variance(# ) <br /> 135"0011 2(Z-(.Z 23 Joe R °€ n N•01).vA. ❑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/) <br /> PARENT PARCEL NUMBER: CURREENTZONING: ACREAGE: El Elevation of property <br /> ❑ <br /> NUMBER 0j9 ®SZ'19y,0—S 4qG5 A'--S I • 6 7 frontage drawn to scale. <br /> TOWNSHIP: SECTION: (p 7 tI <br /> _O��Efrt%I .1/4: '/.'/,: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 15`(3 S. - ' ''aril /e0 D 60+✓ i SSs 75 ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF`REVIIEW <br /> PROD DESCRIPTION: <br /> Zoning D1 tnCt <br /> . ❑This project is a new building or structure. ,Li Permitted Uses <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVI E: PERMIT NUMBER: RLW lAdd SS <br /> EWER DEPTIC (new/existing) <br /> HEIGHT IN F ET: NUMBER OF STORIES: (Not including basement) <br /> 0 W <br /> 2 ► etland/Floodptain/ <br /> Maxi M u,.vt SI'toreland :attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) o^^� <br /> BASEMENT: '1ST FLOOR: :..i EfOSiOnCOntrol permit <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes disturbance <br /> 2ND FLOOR: 3RD FLOOR: ftllin /aCC6S& <br /> -70.0 "A <br /> 0 Rev::tew Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ Q �0� Q Q and available options <br /> (Please round to nearest dollar) �P <br /> 103 ::::::::::.:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::,::::::::::::::::::::::::::::::::::::::::::::::::::::.:: <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 1lo ❑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 1 ' o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [gYes ❑No <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 [ lo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes [) to <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(8/09) <br />