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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO P VIDE <br /> OWNER NAME <br /> 7 -c:-. F-- K L_I t.r K.IJE-IZ ❑ Zoning St s;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed triction; CSM ZU.SS 3LL4E13i r .1'7 L,.i CoTTA6CC 20„/� IA .5--3S 2-7 ar <br /> ce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 0 O S f339 5599 69o8 ZZo i6,48 ic-t_1 r.t t`s e c,-0..2t-T�_ NI E i Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> (City,State,Zip) �- (City,State,Zip) Setbacks <br /> PHONE PHONE ❑ Site Plan proval from <br /> applic e t nship. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ❑ loor ans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> ❑ PARCEL 'y frontage drawn Cale. <br /> NUMBER V I.3/Q7// ' 057-66t,Y-8 i 0. S7S <br /> TOWNSHIP: SECTION: ❑ Drivewa ermits <br /> TorI or t:ur "ems - c 3 1/a:_ 4, / 1414: 5 C state oun <br /> ADDRESS: ( ty'town) <br /> .2 C,SS A/ t^c. gi, ck Z-- h Cc,// &..j C- ❑ Sanita •ermits <br /> CSM: LOT ��'' ++� SUBDIVISION BLOCK/LOA IfJ1 (pU• ,private) <br /> ` f G. MA gr.40 E- -i. j s 7'1/41-0(50 <br /> PROPOSED PROJECT INFORMATION a.TAFF REVIEW <br /> PROJECT DESCRIPTION: / <br /> "D F IL- rJ H U LA S�_ 2�,v T • /c • ® oning District <br /> 'This project is a new building or structure. fib Permitted Use? <br /> ❑This project is an additiL'PTIC alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Aura °• - <br /> 0SEWER (new sting <br /> HEIGHT IN FEET: / NUMBER OF STORI1S: (Not including basement) <br /> ❑ Wetian•°” oodplain/ <br /> Shor= -rid (attar/ ent) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ Erosion • • it <br /> /0(y 4, TOTAL SQUARE FOOTAGE: 4, (SIOpe ,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filth t/access). <br /> I a ❑ Review abort Surrey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ -+ and a t able options. <br /> (Please round to nearest dollar) $ al C.\0 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes liI.No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Tank) ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes 21 No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 5I 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 ID No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 'P No <br /> a v <br /> 6 0 <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) ■ -o. -+ <br />