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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO 7 IDE <br /> OWNER NAME ss <br /> jp/VA1lWJ D, �MI�A 1 0 , ouA <br /> /(Zoning Status; C P; /�7�` <br /> OWNER ADDRESS (Number,Street,City,State,Zip) �' `Deed Restriction; CSM <br /> 20cJ Ea-8 Ito VE O A w+ 5-35c 3 Variance(# ) E <br /> MOM PHONE ELL PHONE E-MAIL ADDRESS S <br /> tJot g3L-6231 '((,,.„ 5r3 -S6Gti 3---p1_,„,„l3aaotC1...,,E. c°,k <br /> X Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTO NAME <br /> oO`rEK A Site Plan including location <br /> AGENT ADDRESS 0,.. ' , Q. CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) Q (City,State,Zip) Xi Setbacks <br /> PHONE P NE Site Plan approval from Q('j'k <br /> � > 3 - 9 �� applicable township. r <br /> E-MAIL ADDRESS `�\ b EMAIL ADDRESS <br /> gFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ( Elevation of property <br /> PARENT PARCEL NUMBER: CUR TZON NG: ACR AGE: p P rty <br /> PARCEL 06 6? ,.'c rp 90/0 j1 ( / s frontage drawn to scale. <br /> NUMBER �J �fN <br /> TOWNSHIP: SECT N: ) <br /> SjII-IAJC�D L d '/a: Y) %%: 'S Driveway per . <br /> ADDRESS (state,count ,tow,') <br /> 2070 EAA RD ✓GIZwvA 4431 53593 <br /> g Sanitary •- • its <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public •rivate ' <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> EXPAND Cvi2Rc.,; CA� y AQA t rO 4 (AIL E tt Zoning District ,. � ,6-c, <br /> This project is a new building or structure. Permitted Use? ►- fn <br /> This project is an addition/alteration to an existing building or structure. St' �` <br /> SANITARY SERVICE: PERMIT NUMBER: 4Rura1 A•• <br /> �( <br /> ❑SEWER ASEPTIC (newt'•• <br /> HEIGHT IN FEET: f- NUMBER OF STORIES: (Not including basement) <br /> /i. ,- ..,i oodpialfit/ AI <br /> o <br /> reland F, •:chment <br /> AREA TO NEAREST SQUARE FOOT: t j 10? �,� ,t.Q <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) r ft cr <br /> ErosionContr0l permit <br /> BASEMENT: t,/A 1ST FLOOR: '+L I TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance,�/J <br /> /`� H 0 +T • <br /> 2ND FLOOR:NYA 3RD FLOOR: NA /`o S F4 <br /> filling/access) <br /> 6 6 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: 1 ) ` <br /> (Please ) ♦ ♦ ♦ ♦ ♦ ♦ �G?� L C C. 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 ArNo ❑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 to <br /> O <br /> 2 Z APPLICATION MUST BE SIGNED <br /> 545-112 taioa> � (Continue on Back) 0 F.r? .0 Ft <br />