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'ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> `PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNEE <br /> e, E7�� Zoning Status; CUP; <br /> QWNER ADDRESS (Nu r,Street,City,S te,Zip) 1/ 535 peed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS �1 <br /> II/ 3'15.51 d r( . e,11T-'C"'hd d.Crwl `1 :ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> to Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ell/septic <br /> (City,sate,Zip) (City,State,zip) ❑ Setbacks <br /> PHONE �. <br /> E PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLus/) <br /> PARENT PARCEL NUMBER: y CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL 6 5 (o/t o O 1.—(((-o 3 A' ( (ex /- (p frontage drawn to scale. <br /> TOWNSHIP: SECTIpN: <br /> 4 rI 1/4: N 1�-1/4: Driv mltS <br /> (stat o ty,town) <br /> n)ADDR SS: <br /> &(p b0 1- 'Ues+ *II £d (.)a v't Wi 53517 <br /> Sanl mits <br /> CSM: / LOT I SUBDIVISION BLOCI(/LQT (publi ,p 'vate) <br /> PROPOSED PROJECT INFORMATION �/ STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 5Gred Zoning District <br /> 6 This project is a new building or structure. A Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: .RU Address <br /> ❑SEWER SEPTIC (ne <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 3 j lit Wetian odplain/ <br /> Shoattachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1 ST FL R: <br /> L] E • onContril permit <br /> ∎a,, �' . .j TOTAL SQUARE FOOTAGE: + slopes, ,istur nce, <br /> 2ND FLOOR: 3RD FLOOR: <br /> .)- 1 ± access) <br /> $ _c ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ --P ♦ ♦ r.. 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 24No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes EiNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? E Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 'No <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) (leave blank if none) <br /> aJ <br /> 6. Is a location survey required? (see reverse) ❑Yes No ❑Don't know <br /> 7. Is this to correct a violation? Li Yes .`No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) <br />