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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME �J <br /> /M ft 5 " ./15.M.40., ❑Zoning Status;CUP; <br /> OWNERADDRE S `(Number,Street,City,State,Zip) Deed Restriction;CSM <br /> �Z Alcor 3 s�yyp•!+¢..� �/ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> i , •c J 7 -'/ O In , , PveAko ow, . II Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 1/t Gr ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ' ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> ❑PARCEL <br /> NUMBER 05-,;_ -'Z.71—BJdo-D C Z 2 - frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> A 2. 5o,A/ 2..7 v.: %41/4: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> Sr3 1-1aw S�� <br /> ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> 2 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> /V !m', i tp' -- ei ,C„,o. ley 4.A,,,,,.5 ❑ Zoning District <br /> ['This project is a new building or structure. <br /> CI Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER pt EPTIC i _7 1D f` „-,O 6 Z V (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> z Z( C LI 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: ❑ <br /> ErosionControl permit <br /> -- 7(9 g 0 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: <br /> 1 ( �( 3RD FLOOR: filing/access) <br /> v" 'o <br /> Sd Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ 3 g , QOO <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 111No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ['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 Ergo <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 ONo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) —0. ♦ --0 <br />