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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> ONER NACiQE <br /> on e, 1S0 ud . CI Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> b S'3 CCCJ, TI`S k J 1-I CI v v (,v Z S- Deed Variance Restriction; CSM <br /> HOME PHONE CELL PHONE b E AIL ADDRESS <br /> 3 7 j Variance(# ) <br /> N---(142-1.1 .(A--3q -55 3 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> SLDTI- 51S0v1 ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> £ S3 C®c.Laz 'Tre4 <br /> (City,State,Zip) (City,'Rite,Zip) ❑ Setbacks <br /> -(I .bu( L)I s":37 if <br /> PHONE PHONE ❑ Site Plan approval from <br /> 6N--- 3 117-35S s applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> N 4 ❑ 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 frontage <br /> NUMBER %/D'.., 3— 8100--1 g drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 2SlSw Y4: /v E 1/41/4: ❑ Driveway permits <br /> ADDRESS (state,county,town) <br /> 337©/33 72 Qua 0. Lori v e �Jo 1,�4-or� Le Z S 3 3-e ei <br /> CSM: LOT l SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> _ 40 I>peel— 06 4,1L ❑ Zoning District <br /> ❑This project is a new buildin or structure. ❑ permitted Use? <br /> V This project is an additio alterationtooan existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 10 t 311 0 0 WetlandtFloodplain/ <br /> AREA TO NEAREST SQUARE FOOT: hCrelarld (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1 ST FLOOR: ❑ Erosion i�tltrQ(-permit <br /> N 4 N a 4, TOTAL SQUARE FOOTAGE: 4, (s�s,distu nce, <br /> 2ND FLOOR: / , fillip access ; <br /> 3RD FLOOR: ) <br /> A)A- N 4- q 2 s y, ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ and available options. <br /> (Please round to nearest dollar) '2 ba p�j <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes al No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 'No ❑Don't know <br /> A)k 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 lidNo <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 jallo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ONo <br /> 5 -7- " APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ ♦ -► <br />