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. , ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER <br /> /1( (- /ii /fi P g Z ❑ Zoning Status;CUP; <br /> OVWNER ADDRESS umber,Str ,State, ip) /- Deed Restriction;CSM <br /> 2 4)d 7 /70/y 4o c d Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS // <br /> ,oe)22/-0 9lb � 207 -7)O2 ,r/� / t°iet @ yv ol"4°46' t-0U Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NA E CONT •• NAME/� �� <br /> � /2 , "1,2/Z7 -G»c h` 11/27` ❑ Site Plan including location <br /> AGENT ADDRESS ✓ l CONTRACTOR AODR of well/septic <br /> 2�Gf/0 nc,E f7/, 2�p0y ,Wjac,L1 , <br /> (City,st State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> i�0ei.2..?/ -Gy c (�6 J 2,2/- "--f—E applicable township. <br /> E-MAIL ADDR 4S /I._" 1 E-MAIL ADDRESS <br /> n / e2rey'7' 0'a/e �, <br /> • h 4eg,re,yo << vrA)Q(A,,ei- ❑ Floor plans to scale <br /> • PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL / ^ �/� q frontage drawn to scale. <br /> NUMBER ° 6 D-7—�6 z`,P6t5C�-9 A-/ /2 gC CA02. <br /> TOWNSHIP' SECTION: <br /> h do 6Y4:,fJw 1/41/4: //CJ ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> e"'e E ca c d, ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Zcr ;/e4,''n5 /S"1� ICS_ ❑ Zoning District <br /> k <br /> . 51 This project is new b iff1ding or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER giSEPTIC S / -2 y 2 (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 /> BASEMENT: 1ST FLOOR: I—. ErosionControl permit <br /> / C/2 2 33 O 4 4 TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> Ss'2 31 Li Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ -+ .+ _ ♦ 266 COCA a 00 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? fidYes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No A 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 la No <br /> `: <br /> Z 3 C' 7 S APPLICATION MUST BE SIGNED <br /> (Continue on Back) —, <br /> 3i2 .-1y/l. Ov <br /> 5--0 <br />