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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> 'PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> 0, ,ER NAME <br /> ' '`L'a =cH`'42 a''i ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 3050 32SPct P,q-55 Sc1,N fZ 4Z,K t L() S3 S 90 Deed Restriction; CSM <br /> E Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> iooj-6-37 3973 ,;o6-66 q- °Z a//e'7. f''c i6"v-a41n.U4-7P6./f e."" d Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> aSite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) a Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS ,�! <br /> u Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us!) <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: Elevation of property <br /> ❑ PARCEL o/z/ // _3oy_23 72' 0 A}_( (��� frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: ',/ <br /> 09 '3 0 1/4: 5 G 1/41/4: /vv" ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 30S0 32e-,occ"Pss - --' /a--t w2 S35 20 ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> yZ (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> "-z-c_rii/ 534e-a 1.3 Zoning District <br /> project is a new building or structure. <br /> ❑ Permuted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> 0 SEWER 0 SEPTIC (new/existing) <br /> HEIGHT IN FEET: r NUMBER OF STORIES: (Not including basement) <br /> /Z j ❑ 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 /> BASEMENT '1ST FLOOR: <br /> ❑ ErOS1tNiCOntrtll, rrrilt <br /> 01 GL /2- x16 _ PQ .5f, /ter/); 1 TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) <br /> i)f ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ 00 and available options. <br /> (Please round to nearest dollar) $ VcOO ' V A�i <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pon s e? ���g❑Yes io ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? IQ). ❑Yes ,.r to ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agr l en'F? .... A ,41 ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? \`S es ❑No <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# 01-)`� (leave blank if none) <br /> 6. Is a location survey required? (see reverse) <br /> OS. <br /> ❑Yes I No C3 Don't know <br /> 7. Is this to correct a violation? ❑Yes Uko <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -. <br />