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ZONING PERMIT APPLICATION www.countyofdane.com q <br /> i <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> S____Z t v c Q Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> `5 i( 1 C ZA o f PnCkt&hck.lt, t,�1 5:3S C.;9 variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (t bS-718'(; c/1) I - t<:itcaz..cS Sic -kz:10c-c-the.r‘ c~~`3'-1 ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME I CONTRACTOR NAME <br /> I n, <br /> \Z. YDM:); Inc. ;__ Ck.cy , c, efik 8.:,:Al X fl Site Plan including location <br /> AGENT ADDRESS {CONTRACTOR ADDRESS of well/septic <br /> S-7C 7 L Vt. cS,. \Iv , <br /> lCity,State,Zip) i(City,State,Zip) Setbacks <br /> M arr;hC.t t t, i S3 `t ' <br /> PHONE ' j PHONE Q Site Plan approval from <br /> &CA`3 i g'- c cf c, applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS Floor plans to scale <br /> '�`CYIe.+�i')4+ ? tct+-zbi�i' s. C ro ❑ P <br /> PROPERTYILOCATION INFORMATION (http:!laccessdane.co.dane.wi.usr7 El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL I ,1 frontage drawn to scale. <br /> NUMBER IOSIV ISV-C)SCC. <br /> TOWNSHIP SECTION: <br /> a�.c' ?a& te_. IS ,/: NE 14 1/4: 3k�: ❑Driveway permits <br /> — (state,county,tow <br /> n) <br /> ADDRESS: <br /> l( 1 (S. \V / ���Ctt A)a.?n lilt SiSZci ID Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> rar<n---_ .“-n3 F�;:‘- Ac:\a14-51 ctl (._C�,_,wFf...eu,. J}tit jr(N) 0 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 FIEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES. (Not including basement) <br /> 32 0 CN ., ❑ Wetland/Floodpiain/ <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: r-, ErosionControl permit <br /> 4, TOTAL SQUARE FOOTAGE: � (slopes,disturbance <br /> x y�1t� filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ''(-AC ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) -iii. -- -4 -41. -∎ --10. $ 6y Coo <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes talc [_]Don't know <br /> 2. Is there a wetland or floodplain on or near the property? lYeslo QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? gYes QNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? IYes QNo <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 agNo QDon't know <br /> 7. Is this to correct a violation? Des [KIND <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -4, <br /> 515-112(9108) <br />