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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU•TOMER TO PROVIDE <br /> OVVNER NAME <br /> jI Z Wing Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ll //Pteria. W/ - � <br /> iI <br /> 7.02— R%` ISIP }I, V 63593 eed Restriction; CSM <br /> ariance(# ) <br /> HOME PHONE CELL PHONE / E-MAIL ADDRESS / n <br /> X r J f 27'- >76y JeAsh t -,' C CiC C aza Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> S' e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE ❑Si a Pla proval from <br /> a pli le township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> I or plans to scale <br /> PROPERTY/LOCATION INFORMATION <br /> (http://accessdane.co.dane.wi.us/) <br /> PARENT PARL wBER: NOCvENTZ ` G ACREAGE: levation of property <br /> rtY <br /> El PARCEL <br /> frontage drawn to le. <br /> NUMBER <br /> T� IP: SECTION: <br /> ie,(-:0/ Ve,p,iQ C:2( y %a: � /\\ %'/: �� ❑ <br /> Drvew ermits <br /> ADDRESS: (state,county,town) <br /> 7 Z /kaa-5 ode R/ 1/clones G -535/3 cas cSM: �l7( LOT SUBDIVISION BLOCK/LOT ❑Sanit permits <br /> 13 (p lc,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> /5 X/ir ;Iiyie 5—y SC' P'l� -i Roo .--7 (f oning District <br /> ❑This project is a new building or structure. <br /> Permitted Use? <br /> [ 1:This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rura 'd•r-s <br /> EWER ( EPTIC � ' (ne /existin! <br /> HEIGHT IN FEET: y NUMBER OF STORIES: (Not including basement) <br /> 15 ' / ❑ Wetland/F dplain/ <br /> Shore! (attachment) <br /> AREA TO NEAREST SQUARE FOOT <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> 7© ❑ ErosionContro it <br /> BASEMENT: 1ST FLOOR: <br /> TOTAL SQUARE FOOTAGE: 4, (slopes,d) thence, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/a ess) <br /> i .70 ❑ Review Location Surve <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ / and available options. <br /> (Please round to nearest dollar) <br /> The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes Io ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Etio ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes ao <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? JYes ❑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) Oyes ao ❑Don't know <br /> 7. Is this to correct a violation? Des po <br /> /� , APPLICATION MUST BE SIGNED <br /> /� � (Continue on Back) ♦ ♦ —► <br /> 545-112(4/08) � U <br />