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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # - <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME /1/1._,2_10-S Gt nd it a >- Pay) I l V 'Zoning Status;CUP; A <br /> OWNER ADDRESS (Number,Street City,State,Zip) _ Deed Restriction;CSM v 2 Q <br /> 1570 �-ft• Rd 1�- &_d .e f -ta n (Al ,.._ ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS /240.1 ' 5 /- 00 9A b i r gcdL t, of • Co ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRA TOR NAME <br /> A ii `)E LP' 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic /(City,State,Zip) (City,State,Zip) , Setbacks 7 <br /> PHONE PHONE _ Site Plan approval from //it <br /> &,0g s4l 00Q0 applicable township. <br /> E-MAIL ADDRESS E-MAIL AUDRES l <br /> b sr* 74, @_ A _�f1'\ ti Floor plans to scale %1 2 (/ k <br /> PROPERTY/LOCATION INFORMATION (http://acc:essdane.co.dane.wi.usl) <br /> PARENT /PARCNUMB �I CURREN ZONING: 2....„ACREAGE: Elevation of property ) / <br /> ❑ NUMBER (,.'✓/i �t: X93"�� itit q 7- * 0 frontage drawn to scale. <br /> TOWNSHIP SECTI ' I �,,/ 1/41/4: <br /> ( ❑ Driveway permits <br /> ] )b)\ /a: //V ►7�" `I� (state,county,town) <br /> ADDRESS: <br /> i570 c ty A Ed l er-ton L( S3S 3(-L gi Sanitary permits Wift <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVI <br /> PROJECT DESCRIPTION: <br /> h UU1-fIan l6 £vI sT/VC. 00 .6u l L c(li1i _ ....s• District 0 <br /> ❑This project is a new building or structure. <br /> CI Permitted Use? <br /> A This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: N/4 PERMIT NUMBER: ' <br /> -- Rural A}. = <br /> ❑SEWER .SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 30 <br /> 1 5 "roK ❑ wetiand/Floadp ain/ - <br /> Shoreland (at hrneht) "--C <br /> AREA TO NEAREST SQUARE FOOT: s O. '� <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ore <br /> BASEMENT: 1ST FLOOR: t r r la Erosion • • <br /> 'Y / l TOTAL SQUARE FOOTAGE: , (slopes,disturb # `, I <br /> filling/access . A I <br /> 2ND FLOOR: ��II 3RD FLOOR ;4 / // � ca � <br /> N L./J Review Locatit t Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ --► ♦ _ .+ ♦ f,. 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? ❑Yes -ti No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes allo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 81 Yes CI No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Ni 5 '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 ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes I No <br /> El0 0 APPLICATION MUST BE SIGNED <br /> 545-112(4/08) on Back) <br />