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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 /> Toe- a ,-,c Fr,"7 ',S kot Fes s e( ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 67/Li Old S avh (?c) pi; dofte1/414, t'J:i 53703- Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (0g L/qq 0190 608 ^yc.0 -6L `to in ei 53?0,c 6 AL- .r e-om ❑Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME e <br /> 3" m i -\/ C it 6./S('ow.6)nS�cu��I ..a Ildef.IJ c ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f of well/septic <br /> a�O9 6‘,,,c.1, ./..4 PFsc 3409 B cIkwoc P�.s <br /> (City,State Zip) (City r�� (City State,Zip) + 1 , ❑Setbacks <br /> Cross P`q.,- 1 W [s T OSS P IAt� S /W S g3 <br /> PHONE ❑Site Plan approval from <br /> 6Og-D-- __S. <br /> —-1 kaS 608- -fie -1i3qc applicable township. <br /> E-MAIL ADD ESS 1 E-MAIL ADDRESS <br /> C 5 <-orS a k CLOC VS I ne 1 GS--- Gc.)h S Ca�T> C.k)s uS,ne l ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: +, CURRENT ZONING: ACREAGE: <br /> ❑NUMBER �70�7-07�( -9c�0 $� frontage drawn to scale. <br /> TOWNSHIP: ]SECTIION: <br /> C - ss P 1°`"'" 1/4: 5 f. %IA: ❑Driveway permits <br /> ADDRESS: pp �� (state,county,town) <br /> 1Zq,o 1�SauY, ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION:, -ruw o c o c 7 ), (9 m e, ❑ Zoning District <br /> ®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: ❑ Rural Address <br /> [EWER FEPTIC )3 —J O I b'-' 00 t s 9 (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 3 1 .1 et a ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shoreland (attachment) <br /> (Outside dimensions including unfinished area a ed ra d5ove grade decks or porches <br /> BASEMENT: 1ST FLOOR: S porches) ❑ ErosionControl permit <br /> 9 I I i'e.�� S��f) 4 TOTAL SQUARE FOOT GE: ,` (slopes,disturbance, <br /> 2ND FLOOR,�ZSy/,� 3RD FLOOR: /� q �,, � filling/access) <br /> L it�-- (P “Ce ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ Q D d and available options. <br /> (Please round to nearest dollar) $ 5 4'7 i O OO. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Igi10 ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑yes o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes U • <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes Oslo <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 I 10 ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes I:54o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► —e- — . <br />