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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 /> I..-- ❑Zoning Status;CUP; <br /> O ER ADDRESS (N mbe,Street,CI S-te, 'p) <br /> oiLSO II Deed Restriction;CSM <br /> LJO S e_ oci 6 l Variance(# ) <br /> HOME PHONE CEL Dim E-MAIL ADDRESS <br /> " <br /> � ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> •G T CO T'•CT R •ME <br /> • ' tS ffilliMildia_.‘ 0 V ❑Site Plan including location <br /> AG S 9 RESS(VQ O/i"Kd TOP ADDREq�r� ad— of well/septic <br /> JJ l l/l/..GG,,//]] U <br /> (City,State, 'p) (City,$tale, 'p ❑Setbacks <br /> PHONE liccie. ' ���� ❑Site Plan approval from <br /> � ��� 3 7 / applicable township. <br /> E-MAIL ADDRESS E-MAIL ADD <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br />' PARENT PARCEL NUMBER: CURR NT NI : ACREAGE: <br /> ❑NUM ER p�//—/yz -3 qb JF-{il frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Ski Prot i`ri 0 / '/a: '/a'/a: ❑Driveway permits <br /> ADDRESS: �-�f / (state,county,town) <br /> J �' I co�'c'��7 [ ' i £&c U� ❑Sanitary permits <br /> CSM: LOT SUBDI SIGN BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT CRIPT : <br /> IO I[/' get-41 ti c. ._- ❑ Zoning District <br /> . This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alt ration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> [)EWER EPTIC / ?... Ze4 ■ AOZ if, (new/existing) <br /> HEIGHT IN FEET: • NUMBER OF STORIES: (Not including basement) <br /> 0' 1 ❑ 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 /> ❑ ErosionControl permit <br /> BASEMENT: doo 1STFLQOR� /� <br /> LJ0 7i, <br /> 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> / �"`� g 6 SG filling/access) <br /> 2ND FLOOR: 3 D FL60R: J <br /> / ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ Sd; OmD <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes to ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes to ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ Yes EINo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years?re [Yes f�lo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# �v-)/ ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Lives ❑No DDon't know <br /> 7. Is this to correct a violation? Lives ❑No <br /> 11 S� - a I/S S APPLICATION MUST BE SIGNED-0 sots ins(4/08)l ( (Continue on Back) -0 -► <br />