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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO P VIDE <br /> OWNER NAME `� <br /> "DCW\ Cx CVO.S \ <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> ❑ Zoning St s; CUP; <br /> 3$50 Sw0608,a_ n VQ�a eed striction; CSM <br /> HOME PHONE CELL PHONE V�dl 1 E-MAIL ADDRES� �'� Va • ce(# ) <br /> (00g-g2,'- - • .' J <A•C,wasZecCx-✓NVe-(S• •elr*. COY? ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME I CONTRACTOR NAME <br /> Qfn'eiSkbKe..la V)51-a✓I scopinglrikc. E-- S C4_4(1/1 Ste Plan including location <br /> AGENT ADDRESS J CONTRACTOR ADDRESS well/septic <br /> P.O. 66X (Q1.05e(p <br /> (City,State,Zip) (City,State Zip) ❑ etbacks <br /> Auk , kls 636 (o ")._ <br /> PHONE PHONE ❑ ite PI approval from <br /> (Do8- 8a4-000c pp' able township. <br /> E-MAIL ADDRESS f E-MAILAD RESS <br /> ;t1CogCorcie_`s�tl cctesi.vlsGe ma&1 San•Cowk loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) e dElevation o f r <br /> PARENT PARC L NUMBER: CURRENT ZONING: ACREAGE: p ty <br /> L:1 UM <br /> NUMBER 052. 01 O$-tc,�{-a-1a5-3 A.I (, 4 0 a— frontage dr n to scale. <br /> TOWNSHIP: SECTION: <br /> �CJI�!l 1 vV1 ( l 1/4: S . <br /> 1/41/4: N ., ❑ Driv ay permits <br /> ADDRESS: 38 JOO ( te,cou ,town) <br /> C� C C .- &., vex ,�\ Wz <br /> ❑ Sani permits <br /> CSM: LOT a6 SUBDIVISION BLOCK/LOT (pU IC,private) <br /> ,, Ac-t \e_-S <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ( <br /> �0��'O c- / / I! " oning District <br /> 114 This project is a new building or structure. <br /> emitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: �� PERMIT NUMBER: C.1 Rura res <br /> ❑SEWER l`a SEPTIC r (r a existing <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> l I ❑ wetlan.)- ..dptain/ <br /> Shur= n nd (atta 0•meat) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) Li <br /> BASEMENT 1ST FLOOR: <br /> roStOn ` " <br /> 2ND FLOOR: 3RD02(g . 5C TOTAL SQUARE FOOTAGE: (S •'•- ,disturbarc = <br /> fillip.,access) t 1.741' ' <br /> CD;." ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ �� 000.ao and available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 eet from a pond or lake? ❑Yes Ili ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the prop rty? ❑Yes lir o ❑Don't know <br /> 3. Have you talked with the township about your proje t and are they in agreement? ales No <br /> 4. Has there been a zoning permit issued for this prop rty in the past 5 years? lld Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/varian a(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes to o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 2No <br /> 41. 1 <br /> 7.— APPLICATION MUST BE SIGNED <br /> 0 (Continue on Back) <br /> 545-112(4/08) <br />