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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> - PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> O1AV ER NAME <br /> PI) lQ V a ' •Q,T'- ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,sheet,City,State,Zip) u Deed Restriction; CSM <br /> ZCI 3(1. pe i,1 ,, U l(,Ita„Z Variance(# ) <br /> HOME PHONE CELL PHONE L E- AIL ADDRESS <br /> 'l!_ % i -.. l2 /, 0$wN� i" «Z £Q 2 3 ft 0. 6 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CON RACTOR NA E <br /> C LIAQ ,� 1 IVO iril4(alv 1514 d of It l$' ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS "� of well/septic <br /> some as pr'oirty oalleC-N6 mciiiiciip i- P.o. OY 22d <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> QroLONSV i//a to S/3/0b <br /> PHONE <br /> PHONE ❑ Site Plan approval from <br /> R 20 43--Z_<3y/ applicable township. <br /> E-MAILADDRESS E-MAIL 1ADDRESS I // <br /> VO I ►1' r ii k orbs r, i iditi)h Q 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 /> L PARCEL /� (� Cr rontage drawn to scale. <br /> NUMBER 012104 P-11 t a -� <br /> {it 703q-2. R-! !• C 1 <br /> TOWN b r(.s1-O I 0/\ SECTI N: <br /> �� 6 (ril/ _� '/a: S e. %%: S e ❑ Driveway permits <br /> (state,county,town) <br /> ADDRESS Pei,/i at/1.8.y CDUsAr <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCIo>T (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 0 I 0 a r n ❑ Zoning District <br /> This project is a new building or structure. <br /> Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ,.,, / , ❑ Rural Address <br /> SEWER X SEPTIC '}j AMP:Jot of l�,V'r; `16 (new/existing) <br /> HEIGHT IN FEET , 0 / 2 i/ NUMBER OF DRIES: (Not i�nG/udi�ng�basementV)���/ ❑ to plain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> 1ST FLOOR: <br /> ❑ ErosionControl permit <br /> BASEMENT <br /> Jj 0p Q I °7 OC> j TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> r V (r V filling/access) <br /> 2ND FLO'' <br /> /OD3RD F OR OR: <br /> /OD t( Ilk)©Yw- i 2 b0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: "� and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ -• $-+ $ / Z/,c3 , Ob p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes cij No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes A No LI Don't know <br /> 3. Have you talked with the township about your project and are they in Ory (LYes ❑No <br /> 4. Has there been a zoning permit issued for this property in ❑Yes CO No <br /> two <br /> 5. Is this project associated with a rezone/CUP/variance(pet ion/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) .3...2;,.,�;3 CI Yes ONo CI Don't know <br /> 7. Is this to correct a violation? ‘)EC �EC ❑Yes A No <br /> .,ro rUr"'' APPLICATION MUST BE SIGNED <br /> 545-112 ta/osl patio (Continue on Back) ♦ -► <br />