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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> O ER NAME 1 <br /> OKI N O f CI L I'�'4 r1/4 0 S / Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 5 W Deed Restriction; CSM <br /> GU? ba g JftSOt. (-- e..4 (A‘)e 'b►Am w' Variance(# ) <br /> HOME PHONE l CELL PHONE E-MAIL ADDRESS <br /> \5-a15" 1`o-3 Cc• (�lwhr �1 d u 4buc , C CI t-V-, ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME ��,� <br /> Il�a,e�00 6- t CMST. -I-A.C —1 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> c, fax C..-- <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> De 7o,ST w 53 3 - <br /> PHONE PHONE Nor e township. <br /> approval from <br /> toot - �-t4 -`10Sl <br /> E-MAIL ADDRESS E-MAIL ADDRESS tt_ <br /> 1 to dbc • , -conAtivc'hvn, (Crti ler or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evation of pro ert <br /> PARENT 'PARCEL NUMBER: CURRENT ZONING: ACREAGE: P y <br /> ❑ PARCEL frontage drawn to to scale. <br /> NUMBER 0 1a1v°III -3c3-qv-O LI 28isl10,16 5b4-t' <br /> TOWNSHIP: SECTION: <br /> --A e-1 ,.--1--0 L.- 5 w ,/4. J k) /%: ay permits <br /> county, <br /> town) <br /> ADDRESS: <br /> al 32 i< q ; e _1_- O(. . L h L_I Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> 4c- 30 i-4' AllE 6 - s;b�.GAQ.Di.0 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> �i c 6t..t5 4-24 r►1 i�I 4 ) Dr'N CE oning District <br /> . a This project is a new building or structure. Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> I - ral Address <br /> ❑SEWER Li SEPTIC 5 ,g a a-R- el /existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> .-aN3 Fr` 11401 ,,� 'Wetland/Floodplain/ <br /> AREA TO NE ST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area. attached garages and above grade decks or porches) <br /> osionControl permit <br /> aeee..,•.T 1ST FLOOR: <br /> tiNg D-- g S j/ 14 y TOTAL SQUARE FOOTAGE: j (slopes, disturbance, <br /> 2Nu rLuur<: 3RD FLOOR: 1p filling/access) <br /> -- d a 7 6 a iew Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -• 2 �� > and available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ®No Li 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? ©Yes ❑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 ®No <br /> APPLICATION MUST BE SIGNED <br /> —11 91 D' ���� (Continue on Back) ♦ -+ —* <br /> 545-112(4/08) <br />