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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 /> a peA 0r4 dI-€ ❑Zoning Stat s; UP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) / Deed Restri 'on; CSM <br /> 106 7 i` R.aQ `�.eer7Co/aQ (Az' c3�3/ variance(# ) <br /> HOME PHONE LL PHONE E-MAIL ADDRESS <br /> 'Or 7/�m% 60i-S-740 Z Mbvtad! e code otata-trr.00 0 Site Plan dra to ale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes di nsions <br /> AGENT NAME CONTRACTOR NAME <br /> S.Q(f ❑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.usn El Elevation of property <br /> PARENT PARCE UMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER 0a ell 549t oSls-0 KIA- frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 5 M eot;ri a ..A: wit: ❑Driveway permits <br /> ADDR SS: (state,county,town) <br /> 186 7 gale- leoQ DtergjWoe S ,S5/ ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> Or q a Z. (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> EGIoSar& 4e. do, telig f� LAI l ❑ Zoning District <br /> gl, <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 /> r)EWER i EPTIC (new/existing) <br /> HEIGHT IN FEET r�/_ 7. NUMBER OF STORIES: (Not including basement) <br /> 7 5 ( ❑ Wetland/Floodplain/ <br /> D Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> .—� et 4* s�. p, ,, TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: 1� 7�" �f fllling/aCC @SS) <br /> �-' '- S� ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ q� <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 o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ZYes Ili o <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) Oyes 1No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes pNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► —► <br /> 545-112(4/08) <br />