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4.--F-So="5!*6. 4746-V <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME t _ ._df a I <br /> iaSor 1 }I /e_h ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,,Street,City,Stat p) Deed Restriction;CSM <br /> 3950/ 14I dcle.41 1 "Tr• ihiv eici ✓, or Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGEK NAME k CONTRACTOR NAME <br /> 0 _ ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> V° '3D7( 1.15.9400 <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> 1YlGr ) I's 1)-y-1 , w7 537(/ ( <br /> PHONE PHONE ❑Site Plan approval from <br /> CIOS -414 y •01A:7 3 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ,° C 126164-.." 4 ' I ❑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 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> • Sp Nojd4 le. 1/4' -1/4%' ❑ <br /> (state,county,town) <br /> ADDRESS: 14 ,• - q <br /> 3c a 14 I d aol "Ut/P.t v -1-r • ❑Sanitary permits <br /> CSM: LOT SU:DIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> t toa pop ( 1 Psi -ou S.e ❑ Zoning District <br /> This project is a new building or structure. 144 ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER r)EPTIC , (new/existing) "1 <br /> HEIGHT IN FEET: , NUMBER OF STORIES: (Not including basement) <br /> // <br /> / ❑ Wetland/Floodplain/ <br /> 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 /> yh�pt, TOTAL SQUARE FOOTAGE: ,l (slopes,disturbance, <br /> I1 8 N filling/access) <br /> 2ND FLOOR: 3RD FLOOR: i I WO <br /> fJr /mil L/ <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: rr 0 ` and available options. <br /> (Please round to nearest dollar) '♦ ♦ --I. -� ♦ -•► 'ri9 ®o _ <br /> f <br /> 1. The property is within 300 feet ora 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? DYes JNo ❑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 Ilo <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 Dlo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes Do <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —0- <br /> 545-112(4/08) <br />