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7. <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> )// nwoo 1> / P 11-0 V e-ih P 4)7 4 SSo C. ❑ Zoning Status;CUP; <br /> OWN ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> j'o FO C.,3 7 k-0 e—CBox-.3oct) ed>Getz.`To u,we / 53534 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 108 8-F4 67 .5 WSite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> i. C.-A 2 b R' L n N h ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> F3 z%c/•( r''rk u <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> aocePZ TD N wt __;-35-3f t <br /> PHONE PHONE ❑ Site Plan approval from <br /> -(5 9'70 a 94'3($' applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> s '`RL.)LA N ■ i 0 ,d o ` Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co,dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> '/a: 1/a'/a: ❑ Driveway permits <br /> L fro Ai (state,county,town) <br /> AD RESS: <br /> C-2 fo fames I 11--u e- ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> Co If cod b <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ❑ Zoning District <br /> ❑This project is a new building orf ec�tl A, alb& 1 -c--k, ❑ Permitted Use? <br /> , This project is an addition/altailietierrto an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ IwfiQSILN1Ci?rltrtl permit <br /> BASEMENT: 1ST FLOOR: TOTAL SQUARE FOOTAGE: (lopes,disturbance, <br /> filling/acc ess) <br /> 2ND FLOOR: 3RD FLOOR: <br /> -7 7r ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ Q 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? aYes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes ❑No ❑Don't know ) <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes III-No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes No <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 lirNo ❑Don't know <br /> 7. Is this to correct a violation? . Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -► -+ -. <br />