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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME L �� <br /> II�idOR o { C�C�®h ®ZoningStatus; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zi <br /> .� a� B S LOC. Deed Restriction; CSM <br /> US CD f OV 'e_ &,4,_ ..,,6,.r 7 5 variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608•S3 5.5 . S ._ t t ► t• [t, . 1 - El,Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> CONTRACTOR NAME <br /> i pL B' U IS LL C ®,Site Plan including location <br /> 0 <br /> AGENT ADDRESS 0. a^ CONTRACTOR A of well/septic <br /> ( aBa it\son R(, <br /> (City,State J ', , fIt (City,State,Zip) rxi Setbacks <br /> PHONE PHO Mail 6SE 5 soa ❑ 'te Plan approval from <br /> 6 0 8 89-7 8 9 a9 Applicable township. <br /> Tatar E-MAILADDRESS ' / <br /> [.{,floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: !� CURRENT Z NING,i (� ACREAGE: IN <br /> ❑NUMBER /Maio SOq-o1a-$9OQ' t - 1 f� r.D5 n frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 316 %: N W %IA: NI w ❑ Drivew: •ermits <br /> Q M' O t\ (sta - e u nty,town) <br /> ADDRESS: J <br /> 5._ - Lo . . - i • .. . •' i♦___IP • 4 - ❑Sanita N 'el-hilts <br /> CSM• LOT UBDIVISI T BLOCK/LOT <br /> (put:W., ,,rivate) <br /> PROPOSED PROJECT INFORMATION <br /> TAFF REVIEW <br /> PROJECT DESCRIPTION: �� Zoning District <br /> WCOCI R --t Prone/ L CIo-c1 Sk Fa p ore M,�.chuN' el <br /> . RiThis project is a new building or structure. ►I Permitted Use? <br /> This project is an additio alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: N ❑ Rural eS <br /> FT EWER EPTIC (new/ xistin <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not in luding basement) <br /> av 1 ❑ Wetland/FI odplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shorela (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: I—, Erosi Control permit <br /> TOTAL SQUARE FOOTAGE: ,l (slopes,disturbance, <br /> 60 x la filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> _ <br /> ) 7Q20 ❑ Review Location Survey 0 <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ , ® ® o and available options. <br /> (Please round to nearest dollar) $ -9 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes wo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes RNo ❑Don't know <br /> `.1 <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? 7,1 es ON <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 0 N ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545-112(4/08) <br />