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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAM <br /> re, o,.y vQCse_✓) ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> -72IY %ri, kt/iL A- Ate t' 53-S2-9 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 402)-S-041--82/I 'ddev ksevi 4 hofrnai I.Conn ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Same_ Cu pfc✓n« S,,.te QJ 04.14cr' ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us!) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL agog-b(l3-2067-`I 1Z- IA i, gg frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Spray''p/d 04 14: SY 1/4 yi4: NW ❑ Driveway permits <br /> (state,county,town) <br /> ADDRESS: `, <br /> ?-3t SP"^5 j J4 Dr , D:,..,. , (Air S3 SZq CI Sanitary permits <br /> CSM: ` LOT SUBDIVISION BLOCK/LOT (public,private) <br /> , ,,,;gJeliL pJ / ?" <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 4.4A cf�ea/ Gq yq, i iic,1 30 x `10� ❑ Zoning District <br /> 51 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 /> ❑SEWER 51 SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 'l k i- le %elf 1 ❑ Wetlandl la)n/ <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: ❑ Contwl <br /> Z 0 Q 4, TOTAL SQUARE FOOTAGE: 4. (slopes,disturbance, <br /> fil(ing/access).. <br /> 2ND FLOOR: 3RD FLOOR: <br /> — — i Z a 0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ f D Q 0 D and available option. <br /> (Please round to nearest dollar) , <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? Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? "Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ,Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blarils if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes 3No Li Don't know <br /> 7. Is this to correct a violation? ❑Yes ` No <br /> :c -- APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) t,l 0 ` <br />