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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 /> S4-o II' Eel` r'c_3 ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 9 5 Io Gi.•ce„..... C3h.'A #A/o /7;.[o(te-tz,., C✓1 535-62 Variance(# ) <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS <br /> 609-6'33-VS2o `o8-CG9-y3y3 RI_EA)O/ E5 @ G!ie is. Nei-- ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 71-4--- /forme owner LI Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,Stale,Zip) (City,State,Zip) LI Setbacks <br /> PHONE PHONE LI 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: CURRENT ZONING: ACREAGE:i,t78 ❑ Elevation of property <br /> Li PARCEL frontage drawn to scale. <br /> NUMBER 0708-3A3 G/C6-O A--1 47 oQq 5,F <br /> TOWNSHIP: SECTION:31 TIN 4'SL <br /> /t1)d41E+n SE 1/4: 5W 1/41/4: LI Driveway permits <br /> ADDRESS: (state,county,town) <br /> 752g 4r /-17„, Dr t4,- 4 is)I 3 S 3 <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 4/ti�;er's 41ooc4 s /(o (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Alec.. s%..S/c 4,,,;/y ❑ Zoning District <br /> Id 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 /> ❑SEWER ,SEPTIC 578 Pi g (new/existing) <br /> HEIGHT IN FEET: r NUMBER OF STORIES: (Not including basement) <br /> ,�2 / LI 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: 1ST FLOOR: ❑ <br /> ErosionControl permit <br /> j TOTAL SQUARE FOOTAGE: + (slopes,disturbance,3 ;�y 3 �—!— }3 I 7 4 g/ <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> /VA A/A 711 1 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: <br /> ♦ ♦ ♦ ♦ -I. ♦ and available options. <br /> (Please round to nearest dollar) �j/(J� trafl <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 4 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) LI Yes eSI No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> 7Cn( 0-0 o /S APPLICATION MUST BE SIGNED <br /> I.D (Continue on Back) -i -4- —► <br /> 545-112(408) G r <br />