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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 /> net.5 4AALS k") <br /> /I Zoning Status; CUP; <br /> OWNERADDRESS (Number,Street,pity,State,Ziq Deed Restriction;CSM O 1wZ Variance(# <br /> ) ti©a HOME PHONE CELL PHO N( E-MAIL ADDRESS <br /> 6 W 832 4'41 S (got E76 fie egttianSoA_ SI e vKsn. Co-u-- at�,►- Site Plan drawn to scale 6 / G <br /> AGENT INFORMATION I CONTRACTOR INFORMATION <br /> AGENT NAME CONTRACTOR NAME r f /2 <br /> ,Site Plan including location 1 <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> (City,State,Zip) (City,State,Zip) El Setbacks g o/i 2/ ' (Q <br /> PHONE PHONE Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Z.Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) / Elevation of property e <br /> AUMBER PARCEL ?NUMBER:/E V'"�O8a- URRENT�NING: ACREAGE: 'L frontage drawn to sca . <br /> TOWNSHIP: Q SECTIO�j:/A 11 S Air-_ ay permits <br /> S ,d r (/.,�{' 1 �- Ia �4: `-' £ %a : <br /> ADDRES :/ �� ? �� COUnty,town) <br /> 4.... y i gSanitary s <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> e—___ ,_ (public vate <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: 1 / <br /> ACrR,•11�ial o�t�a-c. i3c1/calNG (Gni5;/LUC- ss) ?D Xt/2-xZII Zoning District A -1 <br /> IThis 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: lif RuraaI Likek,c <br /> EWER rifEPTIC (ne Xlstir <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Z- / --„- - I Ioodplain/ 0 0/ <br /> orelan. attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or pore == <br /> BASEMENT: 1ST FLOOR: <br /> j� ErosionControl permit <br /> 3 3 6 4 4, TOTAL SQUARE FOOTAG- , (slopes,disturbance, i <br /> 2ND FLOOR: 3RD FLOOR: / filling/access)vo f 6 r <br /> 3 3 C. 0 C<Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ � 0 and available options. 4 <br /> (Please round to nearest dollar) O V l 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes QNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies jVo ['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 EINo ['Don't know <br /> 7. Is this to correct a violation? ['Yes JN0 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />