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ZONING PERMIT APPLICATION www-countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNS ME <br /> Va(o-v t - tAi c- 01'tl ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Numbe^r Stree City,State <br /> g$ Z 4 !y 1- bey 1 r IA-c E D (2,. CM VI 1,( 11' Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Go g7. 832 -Gc 4a 6O ' 6-tr-2 see) 15.-6o Ae L.,-)C c to 0, L-' s .GQ ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑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 ❑Elevation of property <br /> ❑ <br /> PARENT PARCEL NUMBER: CURRENTZO ING: ACREAGE: <br /> PARCEL frontage drawn to scale. <br /> NUMBER p70$ -3 �-3-01133-� �I .y2$r <br /> TOWNSHIP: SECTION: <br /> `�/ ' '/4'/4: ❑Driveway permits <br /> 7iowt �j r—� 'V «' �j /4: (state,county,town) <br /> ADDRESS: <br /> 3311 $)1+-4-A&et.) t...i A 7 ❑Sanitary permits. <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> 33 7/V,�GI b14-5 E./JO <br /> PROPOSED PROJECT INFORMATION `STAFF REVIFcW <br /> PROJECT DESCRIPTION: < al <br /> yj,/w /4-rxj j.. ❑ Zoning District <br /> . this project is a new building or structure. 'i« ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEWER EPTIC 13 _LD f L - o n 2 2...c (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <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 7 1ST FLOOR: Y0 6G 2 ❑ ErosionControl permit <br /> 3 Zo o 3 2.0 D 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ --► ♦ ♦ ♦ ♦ 6 0 o n and available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes IgNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑1'es 'lo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes Silo <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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 'Rio <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545-112(4/08) <br />