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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION te"" <br /> OWN R NAME r CUSTOMER TO PROVIDE <br /> 5 nt ant (in Pewit/11w Zoning Status;CUP; 1'16 / 2 <br /> OWNER ADDRESS (Number,Street,City,State,Zip) _ Deed Restriction;CSM <br /> 557 I PHONE I" h CELL PHONE r ' E-MAIL AD5 ES. 71) Variance(# ) �`�h <br /> OME/ O0 W 73C / r► I.�, (�/�/V�l�l! • C 1 1 ,��1 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACT R NAME <br /> CO(W Zsite Plan including location • <br /> AGENT ADDRESS CONTRACTOR ADDR SS of well/septic <br /> Sag (and DunnTown lliitt • 3 <br /> (City,State,Zip) (Ci ,State,Zip) Ry I Setbacks h � <br /> S Iron, w I 635gi 117Th / 0 <br /> PHONE PHONE Site Plan approval from <br /> ---78(90 applicable township. / <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ,I a t , w ! oQ _ •x 0 y ,a Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) .�. /'/1 <br /> PARENT �PPA CEL NUMBER: <br /> 1 p CURRENT ZONING: ACREAGE: i�� Elevation of property `1 <br /> El NUMBER 04 050i-1(�4-I 7-s8-3 (Z-3 0,g frontage drawn to scat � <br /> ' <br /> TOWNSHIP: SECTIO : <br /> Or Non e-tbwn) 14: J )' 1/1/<: $ F ! Driveway permit <br /> ADDRESS: (state,county,t Ur <br /> CSM: <br /> 55-11 Qa(OT I �-�/1 UBDIVISION BLOC OT Sanitary •-_!• L-� e 4T""" <br /> Z U r I .2414 7 (Public ' <br /> 1l . <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT�DESCRIPTION: ,/ <br /> a-stix Mat On ID 1 ck. of kovtS� 4- 3F' ( letatie fl tdcc(�, )(Zoning District p_3 w y. <br /> . ❑This roject is a new building or structure. ■1J L' <br /> Per 'tt d Use? <br /> This project is an addition/alteration to an existing building or structure. A /j 0 I <br /> SANITARY SERVICE: PERMIT NUMB R: of 4"Rural Add -ss / <br /> EWER XEPTIC ( 0_14 '-tt' (new/:a <br /> H <br /> / <br /> EIGHT IN FEET: ?/- OF STORIES: (Not including basement) <br /> I loodplain/ > 3 B d <br /> horela (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) AfErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> rj� 7 00 , TOTAL SQUARE FOOTAGE: j (slopes,disturbance, CJ 4 <br /> 2ND FLOOR: ✓ 3RD FLOOR: filling/access) -(Q <br /> 61 5 g XReview Location Survey ^Ti <br /> ESTIMATED CONSTRUCTION COST: C}� r�O / and available options. <br /> / • /�' <br /> Please round to nearest dollar) b I /J b <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes ao ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes N o QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? :Yes • o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes @ Jo <br /> 5. Is this project associated with a rezone/CUP/variance(pgtil• .-_ - • ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) U es jlo EDon't know <br /> 7. Is this to correct a violation? III'_ alo <br /> / 1L v 0 APPL ATION MUST BE SIGNED <br /> 545-112(4/08) (C• inue on Back) -► <br />