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. ... z.„/. , t <br /> • 2 J- ..t TD--A, . <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTO ER TO PROVIDE <br /> OWNER NAM <br /> Gott + U 6Q_�r <br /> G Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street City,State,Zip) � r <br /> 2_6 ( 0 5-C-&Ai-N. r0 o k �.t T"R{c.Wour �= 5 37 I I Deed Restriction; CSM <br /> T" Va 'ante(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS , <br /> (,0 H-26 --6068 608-661 -0Z1.3 5+ paz- --4-I-t @ Ya_koa ,.Cowes Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME t I <br /> -U t"l,y /-1 Li 1— ltd Site Plan including location <br /> AGENT ADDRESS CONTRA T ADDRESS of well/septic <br /> 3 I g 3 �e A- Tr- .�,� <br /> (City,State,Zip) (City,State,Zip) LY Setbacks <br /> Mckt5u� w 53-711 ,: <br /> PHONE PHONE 3 47 e Plan approval from <br /> 6 o t— 4 9 - 3 3 I S applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> W,-- � <br /> / loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> PARENT PARCEL NUMBER: CURRENTZONING: ACREAGE: p p y <br /> Li PARCEL /0 2-3 0 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> J ekrO I^p._ 314 '/4: ' 1 6 k/ %'A: R g- riveway permits <br /> ADDRESS: (state,county,to <br /> Q 10 anitary permits <br /> CSM: ` / _ OT SUBDIVISION BLOCK/LOT <br /> �G- 'rr°' (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> • <br /> PROJECT DESCRIPTION:lU� l Q l L C4 frI S'f r�(A--` o L, Z;n <br /> ing District <br /> . &his project is a new building or structure. ,rmitted Use? <br /> LI This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: �j Q❑ ' al Address <br /> CI SEWER SEPTIC / u 2 ,/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> ,Z etland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attJachmF <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: ST FLOOR: ❑ ErosionControl permit <br /> 7 �� �12' •- o o (312/0 <br /> j TOTAL SQUARE FOOTAGE: + (slopes,disturbance, IIP- <br /> c— fillin. a -ss <br /> 2ND FLOOR: '3RD FLOOR: 3 9 ,ft ✓ � <br /> ESTIMATED CONSTRUCTION COST: �. � and available options. <br /> Review Location Survey <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ 3 ,'fi/ �' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 'Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes jNo ❑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? LI Yes ,eNo <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 jVo ❑Don't know <br /> 7. Is this to correct a violation? CI Yes /No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) <br />