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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 /> I -l-E. 0Do2E. F21 EOL ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 11 11-16 CUA^tTy (Z. Fb ri Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 08- '14'i 61 7 6o6- 2.1-L 6 Ct 1 +e.c , f r i c 1 e Mt%t i ' wA I=1 •Ste Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> C LEA�`j 8 AIL IN .1 ❑Site Plan including location <br /> AGENT ADDRE CONTRACTOR ADDRESS Of well/Septic <br /> �9fl PAbL( S T <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> v�2�NP I W 53S93 <br /> PHONE PHONE ❑Site Plan approval from <br /> 8 o --3-33-5,55o applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ale,.,‘ e Gt eC( by, Id i rt , cum ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING:6'/F3 ACREAGE: <br /> PARCEL o�2(o _2�{t -i�3 i,5 -3 2 14 ` t frontage drawn to scale. <br /> NUMBER <br /> OWNSHIP: SECTION: <br /> U R t (a u tJ �� 1/: NE, <br /> win: N ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> `11 Li 6 CiAkt- T y ( )A C R / 0 RE C�t o tN <br /> CSM: LOT SUBDIVISI•N BLOC .'OT ❑Sanitary permits <br /> 6 1-%-6 1, (public,private) <br /> PROPOSED PROJECT INFORMATION =STAFF REVIEW <br /> PROJECT DESCRIPTION: ' : <br /> R u N- l tJ ❑ Zoning District <br /> . <br /> This project is a new building or structure. U. Permitted Use? <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER [EPTIC (new/existing) <br /> HEIGHT IN FEET: /7J n NUMBER OF STORIES: (Not including basement) <br /> ` CI NVetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO REST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ /ErosionControl permit <br /> j TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: n�Qy� 0 fllling/access) <br /> t.4`11 ' 0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: --► ♦ ♦ ♦ d� �1�rS.S 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? [Yes ❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ®Yes fNo ❑Don't know <br /> 3. Have you talked with the township about your project y I a t? ❑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) I]Yes OW ['Don't know <br /> 7. Is this to correct a violation? :Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —o--—► <br /> 545-112(4/08) <br />