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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME P r 0Lst .) l L' ❑ Zoning Status; CUP; <br /> OWNER ADRESS (Number,Street,City,State,Zip) �i� / p Deed Restriction; CSM <br /> HOME <br /> /02-PT 4 ESPH�d --*.4 ADDRESS `,ejj k'/ ` --a Variance(# ) <br /> /007:22 f' 7; �� lC//■av, . ;0 .„,■,./ . ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> k-g j c;f j? f 3 42-7- S pz- c- ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> I: ter .Ovals 70,-t, )aoq 41/Avs2&y/ <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Sk...) 1°401,02)r c_di / l)/ <br /> PHONE _ " PHONE / ❑ Site Plan approval from <br /> g"` S 71 F Zv -45-51/4g applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL S/��(. Ftf-rr.. t),. IG frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION. <br /> Z '/4: 1/41/4: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> - ,-1 c- t -_--c" `ASS ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Sj4)6 f f11-i Lc- //pry: ❑ Zoning District <br /> This project is a new building or structure. 1.3 Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: �,/ PERMIT NUMBER: C3 Rural Address <br /> J� <br /> ❑SEWER SEPTIC 5 % , 9_3 (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 /> ❑ ErosionContrc l permit <br /> BASEMENT __ G ( 1ST FLOOR: ��6 a5Ei 4 4 TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> �"(Q�/(�� y'� filiing/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 5* • ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ --► ♦ ♦ Q and available options. <br /> (Please round to nearest dollar) $ c72) �• Z <br /> 7-4/LIT? �( <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ,+�I No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes )INo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? )4 Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes titiNo <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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ONo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -► -► <br /> 545-112(4/08) <br />