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goo +- c • / 0 OCR Dcr�p ZOIC- 6� • <br /> _ �l <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#_000a) -co 90 5 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> O R NAME \ <br /> . Ci&\�5 RO_ `\0\_G `.Q\� +0 <br /> wN.0 ❑Zoning Status;CUP; � � 'v <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> o2\3 a �W 0 j� � �\ Deed Restriction;CSM ,-eCD4cl. <br /> � S3SZ Jr- variance(# ) <br /> HOME PHONE CELL PHONE EVAIL ADDRESS <br /> L0$-$3S-3'i5`t6og- -\'.--aO31Gk._,c. ..®bv.�\4..->Q‘ • ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> .\nsakc: o\Lccv.S ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic • <br /> a l a Y41/4)..-k d1/4■,.,K ` fil V 0( , <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks V <br /> PHONE PHONE ❑Site Ppo, from <br /> (� i - $35-�3�% f applic bl ship. ot1j cli , <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> �,\.v.,v.\`t1 1Ey. . .ie,,,.‘ ❑Floor plans to scale ?(t4M bw9 ^ <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi.us/) ❑Elevation of property ���� <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL c 10�-0'13 a-4 - 5 ,�G,c`c3 frontage drawn to scale.W� a Perot( <br /> TOWNSHIP: SECTION: <br /> \Z\��\,��■EN '/a: '/a'/a: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 1\$ 5 aw \y os'L ... .>,. 53SsT 5 <br /> `� � ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 13vAc)t,.•.A.% Coo jc 1,k-kb x as ❑ 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 WEPTIC E'x‘s'sc..... -�5sc-c"nm (new/existing) <br /> HEIGHT IN FEET: NUMBER OF ST IES: (Not including basement) <br /> a a F � i.. ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ <br /> ErosionControl permit <br /> 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> `k 00 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ $ , O and available options. <br /> (Please round to nearest dollar) $ <br /> 1r'The,property is within 300 feet of a stream or 1000 feet from a pond or lake? gYes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yeslo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? es ❑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 ►.4 o ['Don't know <br /> 7. Is this to correct a violation? ❑Yes in o <br /> * APPLICATION MUST BE SIGNED <br /> 545-112(4/08) e <"� (Continue on Back) —► —► —I. <br /> :c4t) <br />