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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN R NAME cZo 1 ' I .e r b Q�T Tom' 11 S M 1 +h ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,C"rty,State,Zip) 1((1� Deed Restriction; CSM <br /> rJ i 0 1 Tow e_r L i n e- RCS M Q fl��\C( I I LU I 3l Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS h,�-t- <br /> COI((n.cc 36x3 s(S c.l(gcbSb k r k( h S M i 44 Ver 1io,i , ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME ,CONTRACTOR NAME <br /> AGENT ADDRESS CONTRACTOR O4 tADDRESS unt I A tr. ❑ Site Plan including location <br /> g0 MaInS± t'oRd( f9.),0 <br /> (City,State,Zip) (City,State,Zip) • ❑ Setbacks <br /> PHONE PHONE VV t1 S ((Q , S' CX 1 G ❑ Site Plan approval from <br /> O 0 r-,3c, (-1-b( 0 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> W0303, rk(36 \14 NA but\,k(1,1 ,COlIv. ❑ 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 /> ❑ NU <br /> NUMBER t8 taw:,3 goad- O E4 -2- LI.g Zp frontage drawn to scale. <br /> TOWNSHIP: SECTION: , �� ❑ Driveway permits <br /> M I�� 2 (� 1/4: 5 w /a/4: (state,county,town) <br /> ADDRESS: <br /> S 10 l Tower 1,(.„,„ t , Ham kc (I W( s 3 S 5 ci ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> &%e■ Ski-a ❑ 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 ASEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> CI • it it one, ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosIOnCOntrol permit <br /> BASEMENT: 1ST FLOOR: <br /> 76C, + TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> -76 8 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: tl and available options. <br /> -I.(Please round to nearest dollar) /% 06° <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? CXI 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 /> 0 c (Continue on Back) ♦ -► - <br /> 545-112(4/08) V a <br /> r <br />