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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 /> Thrall Q,) 4l! ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number, ity,State,Zip) n Deed Restriction; CSM <br /> -7/75 I'I�PS * Ji D(day, tt'J 5337 :A Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> G a "..3L" - O ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> �3ttu e--NAME,, ❑Site Plan including location <br /> AGENT ADDRESS „ ADDRESS of well/septic <br /> 1/75- c;1es R , <br /> (City, i ) (City,State,Zip) ❑Setbacks <br /> 7rlla/lefoi ul c357 <br /> PHONE PHONE ❑Site Plan approval from <br /> (oM _63&-3 g-25 applicable township. <br /> E-MAIL ADDRESS J E-MAIL ADDRESS <br /> 5 'e c, Dn. •° •ki -f ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL -2/4/-G�/'CELNUMBER: M CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> ❑ <br /> NUMBER og�0 .;, .d C / o $ frontage drawn to scale. <br /> TOWNSHIP: n SECTION: <br /> S�In Tel/d! 34'44 1/a: /1,E 1/41/4:SC ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: Zoning District <br /> a S i 40 a dePiim ❑ g <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 inducting basement) <br /> ❑ Wetland/Floodplain/ <br /> f Qa✓e r 1�9;tell 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: I—, ErosionControl permit <br /> TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> I S V° filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> I SOD LI Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ $ and available options. <br /> (Please round to nearest dollar) •p Lp S` <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes fa10 ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes 'lo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Oes lain <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes laic) <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) Ekes talo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes a'4o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ —► <br /> 545-112(4/08) <br />