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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> E.ecotp-I 1,✓scvT1-,G" ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 2 3 O C.A. Si-INo'E R.d 9 V . Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS /� <br /> G O f-952.36 - • !tied 1- - +^iit' ('r"4 t'`"❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> A ENT NAME CONTRACTOR NAME <br /> :EY Per6-1-Ss ti/ IC" /..-✓' be .E' ❑Site Plan including location <br /> AGENT ADDRESS CO RACTOR ADDRESS of well/septic <br /> ii.x.ir Moto-vssr '-'-' s4 As 0t15.../G- <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> va wAri w( 53SI3 <br /> PHONE PHONE ['Site Plan approval from <br /> MAIL,g - 211 - 3k/2.-( <br /> applicable township. <br /> E-MAI DRESS , E-MAIL ADDRESS <br /> `e r- pLK✓SonetI e...30-4,0 <br /> I, ❑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 /> ❑NUMBER *(*0 7—. iii.1C32•° FT 1 g 532 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> •mow M e 1 SPQthtts4)11...4.E '/4: '/a'/a: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 230 Le- C rkle 14 wy 92-- E Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> id (0 40 3 (public,private) <br /> PROPOSED PROJECT INFORMATION =STAFF REVIEW <br /> PROJECT DESCRIPTION:P ersoccK c 1gbeQ <�E Abbtt1 at,' 0)11 ,/ <br /> ❑ Zoning District <br /> . This project is a new building or structure. '>/61 Li Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER r)EPTIC (new/existing) <br /> HEIGHT IN FEET 4 , NUMBER OF STORIES: (Not including basement) <br /> 1 ❑ 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: ❑ <br /> ErosionControl permit <br /> e4- j TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> �C filling/access) <br /> 2ND FLOOR: 3RD FLOOR: ^ <br /> L ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: C and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ 5�� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes i 1' o ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes r' o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es ri o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es IF\INo <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) Dyes o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes P 1No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />