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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME " ) � <br /> 13 r la,n 9- S+Oic_t ` 1 e 1 m Soh ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> A/ l6 f in�5 Lyn') Rd if7u�h Lc7/ 53539 Variance(# ) <br /> HOME PHONE CELL HONE E-MAIL Ab6RESS <br /> „I/,-, - 0.31 Co08-5/3-,, /52 s4-ac I helm ,+ co Cp4-(2J4., tud ❑Site Plan drawn to scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME COh RA TOR NAME <br /> ` John 2eh[,()(vj 1 � v 0,h do i n Q I e Ba/ l d ers ❑Site Plan including location <br /> AGENT ADDRESS ,) CONTRA TO AD R�SIs of well/septic <br /> 7g 94 I,kood rond Ti,t 7d q'IiA&liand Tra 1 I <br /> (city,State,Zip)A, � (Ci te,Zip) ❑Setbacks <br /> dross MAIM / 5350 5-s MOW td, 53 8 <br /> PHON PHONE El Site 1700 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 5th wfn-/e6uddtvs e oko,teto SCit( DI 626(-t's (d et'R ,* 'i I1cb,W)t, ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENTZ NING: ACREAGE: <br /> I=1 Elevation of property <br /> ❑PARCEL �6 3f () l , frontage drawn to sca le. <br /> NUMBER / *b p <br /> TOWNSH P: SECTION: <br /> ver ni n-F C 5-n' 3S% 3 I '/4: '/4�/4: ❑ Driveway permits <br /> s — (state,county,town) <br /> ADD <br /> Z6& Ryas kJ EAU lvlbund s <br /> CSM: LOT SUBDIVISION 'BLOCK/LOT DI Sanitary permits <br /> 3514 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: • <br /> New home Cb n S k h 0 ri ❑ Zoning District <br /> . 20-his 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 /> EWER PEPTIC 13 - 2016 -0o z 17 (new/existing) <br /> HEIGHT IN FEET: I NUMBER OF STORIES: (Not induding basement) <br /> z f I 1/2- ❑ We tland/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 /> BASEMENT: 1 ST FLOOR: ❑ ErosionControl permit <br /> 2.L'00 .W4-CM 31-0 Z j TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> T c� filling/access) <br /> 2ND FLOOR: •R9-tOCR:66.0 14, I b O <br /> 2.../62 S b l Z6 i IT 1 9 , ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ —o. and available options. <br /> (Please round to nearest dollar) $ 5 Z( ) ow <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 ONO ❑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 lIgNo ['Don't know <br /> 7. Is this to correct a violation? [Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />