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- ZONING PERMIT APPLICATION ww.countyofdane.com SUPPLEMENT to Web-App # <br /> w <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> Joan °s6 e-r3 g_Zoning ADDRESS (Number,Street, Ity,State,Zip) Deed Restriction;CSM <br /> 5 20 C o e-/1 I " d , W Ulf&r l Oa, vii 5 3 S 9 y Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS 1� <br /> H -C$-3 i S-3 u3 i ..; ,,v614 e, Q,Ij o+,-cs g I I, c..on. 'A Site 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 ADDRESS CONTRACTOR ADDRESS <br /> of well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks 3 6/iô/'s J <br /> PHONE PHONE Site Plan approval from, / A- <br /> pplicable township. #' 1J <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 4 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) '� Elevation of property <br /> PARENT PARCEL N MBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑ PARCEL i fronts a drawn to scale. <br /> NUMBER 0 2 O�J I -11.9-7/50 , r t g <br /> TOWNSHIP: D SECTION: <br /> -ski h f r 0.i P' j e- I "2. '/4: S f '/a'/a: S Driveway permi <br /> ADDRESS: (Scat ty Own) <br /> S 0 3 �r co 5 p -`'p >r L. ❑ Sanitary permits <br /> CSM: — LOT CJ SUBDIVISION BLOCK/LOT <br /> D raJer's Wo Wood c (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: L, / - g // <br /> S j hi 1e— �0.1,--) -i l P 17 0 tY) e-- 1/" C Zoning District K— I �(r�' � 4 <br /> 3 This project is a new building or structure. Co v f2,4-1 7 <br /> XPermitted USef Fi <br /> ❑This project is an addition/alteration to an . I ding or struc /� <br /> SANITARY SERVICE: ERMIT NUM R: ddress <br /> ❑SEWER SEPTIC .Z C� 3 it new xisting) .5e5 `u <br /> HEIGHT IN FEET: ER OF STORIES: jplot.iaetndITTOasement) <br /> Wetland/Floodplain/ / <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: �1/ QErosionControl permit NM,3,)/ ,l TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> / filling/access) <br /> 2ND FLOOR 3RD FLOOR: 1 9_3,-a��� <br /> N Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ Q� and available options. <br /> // rr(Please round to nearest dollar) .p 3 <br /> 00 DO . b O <br /> �b CIY <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes SiNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 'No LI Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? iitYes LI No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 1'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 St No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ii1No <br /> ����/r' �� 3 ,o/ APPLICATION MUST BE SIGNED <br /> 545-112(4/08) '�:i�� '� (Continue on Back) -► -i <br /> ' 1 • / <br /> 7 <br />