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, ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME/Li /'� <br /> �� Antic'ce r��- �� Zoning Status;CUP; <br /> O NER ADDRESS Number,Street,City,State,Zip) 'eed Restriction;S� 7\ ),v l n 1 st ction;CSM <br /> �i Q n Kam( Variance(# ) <br /> HOME PRIME CELL PHONE E-"�IL S <br /> �u �'ADDR� t CIA po .CQ ■ ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site Plan including location <br /> AGENT• 0 DRESS CONTRA ,-ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Ill, Setbacks <br /> PHONE PHONE n proval from <br /> applic a nship. <br /> E-MAILADDRESS E-MAILADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 111 •Elevation of r0 e <br /> PARENT PARCEL NUMBER: CURR TZONING: ACREAGE: P P rty <br /> D PARCEL NUMBER 0 F'f/1. "/53-7 y7J— / )S frontage drawn to scale. <br /> c <br /> TOWNSHIP: SECTION: <br /> ft)" / O 1�4: u h/ 1 1 ►' •rl ermits <br /> P/�t.��� St sS t' �4 X4:5 (st ,c nty,town) <br /> ADDRESS. I <br /> O 9 S-111 /11 it\ /,c- �- �� k Sa • ry p its <br /> CSM: LOT SUBDIVISION BLOCK/LIt T <br /> /Y}rinScl v■ f'0./k 3 )-- (Pub• , rivate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> S — - �— 1 r Zoning District <br /> This project is a new building or structure. RI 4-ermitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMITN ►! "ur. ,crr-d_ <br /> EWER C r�)7J (ne existin• <br /> HEIGHT IN NUMBER OF STORIES: (Not including basement) <br /> —4.— r 41:.. _ 9 o...®lain/ <br /> ttachment) <br /> AREA TO NEAREST SQUA E FOOT: 14.0 06, -- <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: Io Erosu3nContrQt permit <br /> j n j TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> / l� filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 0 <br /> �-=` = -.view Location <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ - 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 ❑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 ❑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 ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) ■ —► —► <br />