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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 /> &-7%*Y /t--2*---��� ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> _3,7Sj'«' Ai"mot°., co-7-7 -,Cov� e-t7_7 Ste_`5.-2__ Variance(# ) <br /> FJOME PHONE CELL PHONE E-MAIL ADDRESS <br /> a� 4--2Y---77 -,' .54—&-" ,C�Tc_,'Ca vS_' e y,01-h'oo_ c--c.----1 <br /> ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ��� -- Ga/s'' ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3s7-,' ..' . •5��a-" /<e9. <br /> (City,State,Zip). (City,State,Zip) ❑Setbacks <br /> cGi' £ �,c0v /-t -- .335 7 <br /> PHONE PHONE_ ❑Site Plan approval from <br /> 14 ) 2 —y- `f applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ir eco-,vs_ e, -� . e <br /> El Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dlane.wi.us/) 1:::1 Elevation of property <br /> PARENT PARCEL NUMBER: CURREN OVI ACREAG <br /> ❑PARCEL <br /> UMBER °�// �'���s_G. /' ^ ( o frontage drawn to scale. <br /> TOWNSHIP: SECO�j <br /> Co 7 74-C 6'/ccv�� °°� '/4: 1 v E 1/414: S )%) ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 3 5-5-y �,9vAf7oti e• ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> •ic"..- ,� -�1z___.irJ /,e' -.av�L_ ❑ Zoning District <br /> ❑This project is a new building or structure. ❑ permitted Use? <br /> [This project is an addition/alteration to an existing building or structur . <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEWER ,�EPTIC (new/existing) <br /> HEIGHT IN FEET �/ NUMBER OF STORIES: (Not including basement) <br /> I 1 Z ❑Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT /A.... 1ST FLOOR: ��� ❑ ErosionControl permit <br /> ,6-E ti =- ,` TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> '.mss filling/access) <br /> 2ND FLOOR: 3RD FLOOR: � �� ;Z;21?--- Y°1- <br /> � X • L/ 0.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: <br /> -4. ♦ ♦ ♦ -1. ♦ o� and available options. <br /> (Please round to nearest dollar) 7Gr OGG <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ao ❑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? res ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ]Yes ❑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 ❑No &Don't know <br /> 7. Is this to correct a violation? [Yes ,JNo <br /> 1 e"�,i APPLICATION MUST BE SIGNED <br /> 545 112(8/09) <br /> '�-1 <br /> G-„5-- (Continue on Back) -► ♦ -i/0 r'S ' <br />