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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME I <br /> 0,117 ❑ Zoning Stat ,CUP; <br /> OWNER ADDRESS umber,Street,City,State,Zip) eed riction;CSM <br /> A-icku2 t.O\, \2 C°_A-OSS,S\c c 41 , Va . ce(# ) <br /> HOME PHONE CELL PHONE E- AIL ADDRESS <br /> b\LS-SSck1/4k S. • C: L•Lbet-.1 SkabLo5Q10t,ma:j•(am Site Plan drawn to scale <br /> /' AGENT INFORMATION I CONTRACTOR INFORMATION d includes dimensions <br /> r AGENT N ME CONTRACTOR NAME <br /> 411 Pj�M� Si Plan including location <br /> i. GENT A SS CONTRACTOR ADDRESS well/septic <br /> , <br /> ti <br /> '(City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE ❑ ite Plan royal from <br /> pplic a township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) n Elevatio of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑ PARCEL 11,, C.) frontage drawn Cale. <br /> NUMBER ols��(c�O O1q 3 o(dYC �C�" , ICJ <br /> TOWNSHIP: SECTION: 's v• <br /> \I e cam\ x --/' -VAT 1/4 141/4: ❑ Drivew permits <br /> ADDRESS: (stat ,county,town) <br /> -D.—Igls. i ∎:.k-02. C.-VOSS.%c\$s .\, V e.Od0. ❑ Sanit- • •ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (p . lc,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> t A o&O t e c1 t t ke06 deco ® fling 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: D Ru - i i - <br /> ❑SEWER VI SEPTIC ( /existing <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> CJ Fe e-k, k etlandiFloodp(ain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ Erosion =i . permit <br /> BASEMENT: 1ST FLOOR: (:)....S 0 <br /> 4, TOTAL SQUARE FOOTAGE: 4, {°'.o- , a hstu rice, <br /> ;l.,• access) <br /> 2ND FLOOR: 3RD FLOOR: ,„ I- <br /> ,9 CG/o FM Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <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? I21 Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? DYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? aces ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ' Pg 3 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ."No ❑Don't know <br /> 7. Is this to correct a violation? UYes (ago____‘; ( APPLICATION MUST BE SIGNED <br /> 545-112(4/08) 1 (Continue on Back) —► -i -+ <br />