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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NA�I EI <br /> Ab hg Wj A S PO 1 ) 0 C- 11' , ❑Zoning Status;CUP; <br /> OWNER DRE (Numb*Street,City,State,Zip) Deed Restriction;CSM <br /> 70 N ld/oOr�Cs �' I J Variance(# ) <br /> HOME PHONE CELL PHONE c/ E-MAIL ADDRESS <br /> U 1 = OO 77 0 q Og O p f A (' C / VS- 4 -e t ❑Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> l'ckfr 3ac 0()5 Q n ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> /0y97 H—y V <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> i.PHONE PHONE t > ///t) I 5 3S� <br /> H N El Site Plan approval from <br /> (fog —575- 6716 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 44 Caceerdrj6jj r_eI IC.CoYIN J Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 1=1 Elevation of property . <br /> PARENT PARCEL NUMBER: CURRENT ZONING:gem.. ACREAGE: <br /> ❑PARCEL `� .�/ \ n, �,, frontage drawn to scale. <br /> NUMBER 023/0Ci 01—al 3-001-Lk A'p�.(l J Ocki.' f I 1 5 <br /> TOWNSHIP: 111 SECTION: <br /> Al/TO'N 1-%a: J 1/a'/e:5 LL) ❑Driveway permits <br /> �� �o W ire (state,county,town) <br /> DRESS: <br /> 0 --7oLA k 10-Yke 0-)o A.5jr -1 Lod; 1�\ 535. 5 <br /> CSM: LOT SUBDIVISION BLOCK/LOT El Sanitary permits ' <br /> (public,private) <br /> � <br /> �V PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PRO ECT DESCRIPTION: <br /> 1A06,11}.t0V\ ❑ Zoning District <br /> ❑This project is a new building or structure. Li Permitted Use? <br /> (EIThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER PEPTIC f d/ I/ ill f (new/existing) <br /> HEIGHT IN FEET: 6 NUMBER OF STORIES: (Not including basement) <br /> 1-- ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensioglilicgling unfinished area,attached garages and above grade decks or porches) ■ ErosionControl permit <br /> BASF'""-- 1ST F1 MR- 0 <br /> 22,K e Z + 61C .20 Ic 2 2. -r gin t + TOTAL SQUARE FOOTAGE: ,+, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: _ filling/aCCess) <br /> bU <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ �j 0 0 and available options. <br /> (Please round to nearest dollar) 0 CD <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Falo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Rio EIDon'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 IZINo <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) Dyes `!� o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 0 o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) <br />