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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 /> ` .2-66^ E 3VDy srv2 elk 5 <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ❑Zoning Status;CUP; <br /> 3ZG°I S�C�2f ti-D K D . Pti tribt-e wi-, S 35 3 f Deed Restriction;CSM <br /> J Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (,n-2.07- (5,SI L ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> JUSTIP SC-)44''t.` r SL NM/it 8v/1-P4-6 -0 ple /fi I.'. ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 316 A). A7way° w. <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Dag(/eip, ko. S 35-31 - <br /> PHONE PHONE ❑Site Plan approval from <br /> (90Z-21C-8 2.7(. > applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 5c.1,M l—f/'bldrse. m.1%.err,. C'^ 5 ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL vii 8 2N- t Z.2 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Ca`rIA6-F (r2dVf NIe 1/4: SE- 1/41/4: 3l, ❑Driveway permits . <br /> ADDRESS: (state,county,town) <br /> 326 7 bF.ERfieIO K9. D.44.2FIE4P, w1. 5-3C31 <br /> 0 Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> itkIA.) Holm E ❑ Zoning District <br /> . <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: PERMIT NUMBER: ❑ Rural Address <br /> EWER [EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> I ❑ Wetland/Flood plain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> Zoo() 2, 2$O ,, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> y) 2$ 0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ 3 3 d, u-D D, e� R <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ZNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes Elo ['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 jNo <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 Elo ['Don't know <br /> 7. Is this to correct a violation? [Yes EINo <br /> • APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ —O. <br /> 545-112(4/08) <br />