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- - ZONING PERMIT APPLICATION SUPPLEMENT to Web-App # <br /> www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> SE_all -{- C r il OL 1e ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number•Street,�y,State Zip) • Deed Restriction; CSM <br /> HOME PHON �Y l CELL PHONE Valley E-MAI DRESS Variance(# ) <br /> •0 -S16-11 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> RA�4 � wj�• h ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS --J of well/septic <br /> /6g6 Q;avvc-ovd C;i <br /> (City,State,Zip) (City,Sta e,Zip) l <br /> CI Setbacks <br /> ON/ut Wd s WJ✓9 <br /> PHONE PHONE ` <br /> ❑ Site Plan approval from <br /> d? --,22q- 7 1 O applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.ca.dane.wi.us!) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ NUMBER rq(93634/6330 frontage drawn to scale. <br /> TOWNSHIP: 0 SECTION: <br /> %1 �v�v\-a 1/4: 141/4: Driveway permits <br /> ADDRESS: (state,county,town) <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> t S e 1. ❑ Zoning District <br /> ❑This project is a new building or structure. ❑ Permitted Use? <br /> X This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT F'UMBER: ❑ Rural Address <br /> ❑SEWER 4WEPTIC 1 (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ W tland/Fte od trodp ain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1 ST FLOOR: ❑ l rosloncantrof permit <br /> 4 TOTAL SQUARE FOOTAGE: 4 (slopes,distt��, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ $ `j 00 and ava <br /> 1. The property is within 300 feet of a 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 prop rty? ❑Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your proj ct and are they in agreement? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this pro erty in the past 5 years? ❑Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/varia ce(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 ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► ■ —► <br /> 545-112(4/08) <br />