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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OVVWR NAME �/ <br /> OLr rT e_,6`�") / Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> J 35 7-0 /2 Q/Z 5TO(1&i./T<WI1,41- 5358' Variance(# <br /> HOME'HONE C LL•HONE E-MAIL ADDRESS <br /> 60y g,-n-/5-y3 40; qW- 5 /o5 c—oon , 4 ;I• n2,t Vecite Plan drawn toscale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ 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 /> ❑ PARCEL O 6'135180005 5fie L/ /6, frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> pi_y_A S//47 1j .-S 35 1/a: /H= '/41/4: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> E( .- (public,private) <br /> /0 S E <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> DYE TA C1/,L' &M46 '1" ❑ 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 /> ❑SEWER )113EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) <br /> Iv ! 6 ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> (Outside dimensions including fi <br /> EAT REST SQUARE FOOT:nished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1STFL0gqpp�. ❑ ErosionControl permit <br /> f�� O 4 TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> // filling/access) <br /> 2ND FLOOR: 3RD FLOOR. ! v�1/940 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -► -• -• @ 3d�oD� Oa 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 Zi No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes .Lal 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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 2i)No <br /> 1 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► - -i <br /> 545-112(4/08) <br />