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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 /> 6 e°` r— { .)ne:I ❑Zoning Status;CUP; <br /> OWNER A ESS (Number,St et,City,0, Ca Zip) Deed Restriction;CSM <br /> HO Yd ONEGYN4Y R,J PHONE, Ca04eri E-MAIL--.,r 53S�3 11 Variance(# ) <br /> .23- 3-6 `- .5?6- I c& L-4,ti Q M endue K.Mc T Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONT CTOR NAME <br /> �a�, r ['Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1l0# Pins SIN <br /> (City,State,Zip) (City,State,Zip) [{"Setbacks <br /> a lc..k Cc.t11 6.1_1" sidrir <br /> PHONE PHONE r 'Site Plan approval from <br /> Az -234 7 3i applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> [/]Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) [ levation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> PARCEL Ot frontage drawn to scale. <br /> La NUMBER t;�6G/2•.tYI-�"cct�•-�{ � IEx yc,7 <br /> TOWNSHIP: SECTION: <br /> C 11rvST•c.ko% 1r '/4: Nf '/a%a: /l1a ❑Drivewa •- • its <br /> ADDRESS (state, o nty, •wit) <br /> S'Yc Cd44+7 Poi e ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,iiiigr <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: k 51 It Ice ` pc k s Le-al ('Zoning District <br /> This project is a new building or structure. Csa'�ermrtted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER ❑ Rural Addr- <br /> EWER PEPTIC (new/'j <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not inducting basement) <br /> Z Z I.!t6 / t2red/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 /> 2ErosionControl permit <br /> BASEMENT 1ST FLOOR/O o + TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> S/O0 <br /> ja`Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ /6 •/b <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes MN° DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes o DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes to /VI <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? JYes Jlo <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) QYes t.lo QDon't know <br /> 7. Is this to correct a violation? [-Yes 'lo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -► .4. -lb <br />