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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 /> eC c i7 Co ' El Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street.City,State,Zip)._ Deed Restriction; CSM <br /> 3 L1 gO /'pi 1 0,10 Kd . i /111_45,-1, 1 ''v t S.37-1F Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 601- 22Z-3`12_9" ❑Site Plan drawn to scale <br /> AGENT INFeliPM4TPON CONTRACTOR INFORMATION and includes dimensions <br /> ,.. CONTRACTOR NAME <br /> A,-�- .> t II J 71.)a 376")S- /A.)C ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> /22/ JEn1T-,.2E Q 2 , <br /> (City, taf jJZip). (....cA State,Zip) ❑Setbacks <br /> J'*1/6-cv1Lt-6--‘1- wI 5 3sy6 <br /> PHONE PHONE ❑Site Plan approval from <br /> 612 "— -I-- 6 31' applicable township. <br /> E MAt*DO E&Sip,∎,r,• .- -.....All E-MAIL ADDRESS <br /> CC(-0 el„,a ,,b c , ",,,_5._ Co„, ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> • <br /> ,/4. 1/,/4. ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PFjJECT DESCRIPTION: .','.4- ;_ <br /> Ike—/0 1,1 in of-3ro.n cQ 4 -iii(( Spy n cl,- ❑ Zoning District <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 /> FIEWER �EPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) - - <br /> ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ❑ ErosionControl permit <br /> BASEMENT- 1ST FLOOR: .. <br /> 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> filling/access) - <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ _a and available options. <br /> (Please round to nearest dollar) 16 1 OOO <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 'Jo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies / Jo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? :Yes 'Jo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes EINo <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) [ales 'Jo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes alo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -+ -4 -∎ <br />