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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> MINIM <br /> PROPERTY OWNER INFORMATION CU TOMER TO PROVIDE <br /> OWNER NAME <br /> ■, id he hi/ ' / 0 A41.0, '';'`may . r Z Wing Status;CUP; <br /> OWN R ADD-ESS (N ber,Street,City,State,Zip) eed Restriction; CSM <br /> 9 _I .• & / ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> J�q/'�o->_ ❑ '.ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION ..nd' dudes dimensions <br /> CONTRAC OR NAME <br /> // y/ • e&, f 4,41r--eft / 'A Si Plan including location <br /> AG NT ADDRE S . 7, •- .Do- s of ell/septic <br /> 4�1L� � /� ti ; -L ' cur 2,00 <br /> (Ci ,State,Zip) (City State,Zip) etbacks <br /> PHONE # PHONE El Si - Plan royal from <br /> droy- $L3 - t.{6 33 erg_if g _ a.f lit a township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 1�. - ,, ..0.,-,,,,- - Jar=., 'I•or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ;.--at of propert <br /> PARENT PAR�CyELLNUMBER: CURR .TZONI G: 11 ACREAGE: <br /> NUMBER <br /> RC O'er'!-o 9/-340--° • ^ /.JBO frontage drawn scale. <br /> TOW. HIP: SECTIO : ��'gf. ❑Drivewa ermits <br /> )aa a _e i i r 1/4: Niv ' IA: state ount <br /> ADDRESS: ( y'to n) <br /> .`�/ ` / ❑Sanitary rmits <br /> CSM:,�O5 LOT / SUBDIVISION BLOCK/LOT (' bll rivate) <br /> PROPOSED PROJECT INFORMATION <br /> STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> X• ' „ °oning District <br /> This project is a new building or structure. ? <br /> Permitted U e. <br /> This project is an addition/alteration to an existing building or structure. <br /> a Rural 'ddr- <br /> . ,ii {niw/_ <br /> r NUMBER OF STORIES: (Not inclu•ing.._ement) <br /> C 1ettan oc>dplain/ <br /> Shor nd (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) rat <br /> lialWAIMM 1ST FLOOR: J rOS Oil permit <br /> / /r ''X TOTAL SQUARE FOOTAGE: Slopes Stu bance, <br /> 2ND FLOOR: 3RD FLOOR:� <br /> filling/ Ocess) <br /> A • -=W/ 141 0 Review Location Survey <br /> ESTIMA ED CONSTRUCTION COST: - ' -► $ 50 4 0 • and available options.(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 EDon'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'? Elves ❑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 blank if none) <br /> 6. Is a location survey required? (see reverse) Elves ❑No ❑Don't know <br /> 7. Is this to correct a violation? [Yes EN <br /> APPLICATION MUST BE SIGNED <br /> /& , �' (Continue on Back) ♦ -► <br /> 545-112(4/08) -4( <br />