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SCP <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME �A <br /> (On ( (A.14-0 ❑Zoning Status;CUP; <br /> OWNER ADDR S (Nu ber,Street, ity,State,Zip) Deed Restriction; CSM <br /> 37 L(4 lei ttti t,.0 .7, / F,5,,,. .-37/ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ❑Site Plan drawn o ale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes di nsions <br /> AGENT rtCk / CONTRACTOR NAME w t� am/4 13v,IarC-,0 rc�j/l( ❑Site Plan including location <br /> AGENT ADDRESS CONTRACT F�ADDRESS �) ✓ of well/septic <br /> Vag 61ec, s/ 9"y 61'(t s <br /> (City,State, ip) (City,State,Zip) ❑Setbacks <br /> PHONE xr v. (...3 i cp^�� W / .S 3�3 Site P <br /> PHONE � ❑ Plan approval from <br /> 6.04 - 7. /-z 4 - ) 640 -7‘;/ -7-4--si applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Q :j Z • A ,/^ . lax.t ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER 0410 —'/01.— yili-- l <br /> TOWNSHIP: D 7 SECTION: <br /> • <br /> '/4: %%: ❑Driveway permits <br /> ADDRESS: �� (state,county,town) <br /> 37 Lk, c:(0,0 k J L,),../ / 'Lc - - S 3 7( ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCIQLOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: . /' <br /> U.€d< R e 4 14 ❑ Zoning District <br /> This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER E}EPTIC (neW/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT. 1ST FLOOR: r--, ErosionControl permit 468 <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: n <br /> 1:-.:?e3 3RD FLOOR: <br /> ‘A--- t sg 'r ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ �D,I and available options. <br /> (Please round to nearest dollar) V <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes [ No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Ekes Ro ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? EYes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes ❑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 o ['Don't know <br /> 7. Is this to correct a violation? [Yes No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ -► -. <br />