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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 /> S'Tit TZ ago s- 4:rve-- Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Strut,Clty,State,Zip) / AL,i,z Deed Restriction;.CSM <br /> .2/02- /.2L4aie,4.- 7 - '7m v f'&.a-4( 4/44•06,-; .r S`35-54 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL DRESS <br /> Fay .2-2-5---1-0.17 .2-2-5---/5-37 .Q Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> A <br /> Int.,..A.4.0 NAME. CONTRACTOR NAME /,� <br /> /56,..s-k•--. i D Site Plan including location <br /> AGENT.A_DDRESS CONTRACTOR ADDRESS of well/septic <br /> llo etbacks -- <br /> Tci yam,Stated) ----- (City,State,Zip) <br /> PJa. > ,- ki-<. 5-7s-S 7 Cl au„ 14-4.:. $ 3 s-77 <br /> PHONE PHONE D Site Plan approval from <br /> 0/_ v -? — 6(Kr/ f y y- r?i ' applicable township. <br /> E MAILADDRESS E-MAILADORESS <br /> .,.••4.,./.,.4... Te5 •4-4&"7" D Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn Q Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> -----PARCEL-- = frontage drawn to scale. <br /> NUMBER �• c•W —3s1'�;11a-CG ' / - / <br /> _____TOWNSHIP SECTION: <br /> 3 c •/4: N w '/'/4: .S Lt./ Q Driveway permits <br /> ADDRESS: (state, county,town) <br /> .Z/0 Z 5 5`- 0 D Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> - ' C— f <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJtis.DESCRIPTION: <br /> - iflq�w ie/ p4pif/ w� ,at %n f, s� �2. ' - 0`Zoning District <br /> . ['This project is a new building or structure. 0 Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER 0 Rural Address <br /> DOVER 174EPTIC (new/existing) <br /> _HEIGHT IN FEE'E ER OF STORIES: (Net.ndu,. basement) <br /> r �, °•0 Wetland/Floodplain/ <br /> Ti I/- G I vv v'ur OF <br /> Stioreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT �5TFLOOR 0 ErosionControf permit <br /> 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbance; <br /> .) filling/access) <br /> 2ND FLOOR 3RD FLOOR <br /> 0' <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -► ♦ Q� o and available options: <br /> (Please round to nearest dollar) 'P /7 y )cr e. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Wes r_iNo DDon't know <br /> 2..Is there a wetland or floodplain on or near the property? Dyes ao DDon't know <br /> 3: Have you talked with the township about your project and are they in agreement? DYes l No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes [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) Dyes EINo DDon't know <br /> 7. Is this to correct a violation? •Dies ONo <br /> APPLICATION MUST BE SIGNED <br /> ' (Continue on Back) —0- —► —► <br /> 545112(4/08) <br />