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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER AA. <br /> z. <br /> cd '" E (ie+ft.9� ^ ❑ Zoning Status- P; <br /> OWNER ADDRESS (Number Street,City,State,Zip <br /> I D d Res . tion; CSM <br /> 3 �. 8 brw LA k'v'o roc- !' rian (# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS - <br /> ar 1 .- 5-5-1/ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME < CONTRACTO�i NAM <br /> / t 1 µ f i s �6µ(... .../e4.7 1&ko. 46.4_ 2 1$ ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 7( 8 ' - lit-07 14- <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Ak.-d.d te-t-a.^, "I ( S- 3 S z. <br /> PHONE PHONE ❑ Site Plan approval from <br /> L., 0 �� - c 3 7 `2,51:>3" applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> /:e„,14 e. c 1.-,..y s. - c_f ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCELN MBER: CURREN ZONING: ACREAGE: ❑ Elevation of property <br /> la <br /> NUMBER 0 3 Sro./08 --X13 ,,1? �, .4 i I, ?b 2- frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> At ad (€.-(-6.1 31 1/4: 5 1/41/4: ti' LJ ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 2--5( „2— 1....v i-,,. La.,,___ v,Zr",'.-�v , v'j i 5-3 S `I ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> o b�?.�(P 7 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROD CT DESCRIPTION: <br /> / V X I-o --L7 g r c> A {P,.o , ❑ 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: <br /> / PERMIT NUMBER: ❑ Rural Address <br /> Press <br /> ❑SEWER '6l SEPTIC -- (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ 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) <br /> ❑ ErosionControf permit <br /> BASEMENT 1ST FLOOR: di��� <br /> 4, TOTAL SQUARE FOOTAGE: ,j (slopes, r <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) <br /> I 0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTIO j <br /> COST: ♦ -to. ♦ -0. � •.♦ $ d U © <br /> and available options.(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 allo ❑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 EU No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes tilNo <br /> A, <br /> ------ <br /> (' C APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> Il (Continue on Back) -► -► <br />