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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 /> �Iro.)-7,7r . ,7fR#9;,/ ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 364- 6 2 6 4 4 f K e 's 9 i f 3 c.4 y C%f(l� s ue.,//70,7,43... <br /> 4# /6 J .f 1fl° Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> bag- P3`i- -g1 ear- .r- 57.27 ??A4io o,r .x, 9%c. Ccm ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTR• TOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> ❑ 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 ', 0,,1-4&5 fronts a drawn to scale. <br /> NUMBER 2 °G01f A - 1 g <br /> TOWNSHIP: SECTION: <br /> e' u,4K"r' 2-. '/a: 141%: ❑ Driveway permits <br /> ADDRESS: -'�� (state,county,town) <br /> C.366 67z449C6i ;3,4,4•vzi, C,er�.. J�n,.r7.A,R,,c`./(,v/ J—..3s-9Q ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 6/c+ i 7/c.r✓ !6, ud 6C el' ❑ Zoning District <br /> ❑This project is a new building or structure. <br /> Ca Permitted Use? <br /> a This project is an addition/alteration to an existing"building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER ASEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shoreland:(attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ Erosion iM• rt11it <br /> 4, TOTAL SQUARE FOOTAGE: 4 (slopes,distiurh ce, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 6?, - <br /> - ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ —0 c� and available options. <br /> (Please round to nearest dollar) /000. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 1INo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes AiNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? f,�{Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? AI 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 ❑No ,I�!Don't know <br /> 7. Is this to correct a violation? ❑Yes 124No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) <br />