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ZONING PERMIT APPLICATION ww .countyofdane.com SUPPLEMENT to Web-App# <br /> w <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE/ <br /> OWNER AME / / 1 ; r/ <br /> - -t'1 er liAlf i�� Zoning Status;CUP; --,OWNERA ss (No"�'°r, eec,c scare, , �ta Deed Restriction;CSM I J Pao xceirj.� � (. Variance(# ) <br /> HOME PHONE LL HONE E- ADDRESS <br /> 06..,,�� �. <br /> /.7 AO I /�� 2 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CON�TOR NA 30 <br /> ,0, - et„f-e Site Plan including location <br /> AGENT ADDRESS CONTRACT R a ADD s of well/septic <br /> -ice <br /> (City,State,Zip) (City tte, i )> Q'Setbacks 70 i /D 7 <br /> PHONE PHO / <, O Site Plan approval from <br /> '-!�3S applicable township. sosti J 36 <br /> E-MAIL ADDRE ait''/ E-MAILADDRES Floor plans to scale • <br /> PROPERTY/LOCATION INFORMATION (http://ac.:essdane.co.clane.wi.us/) I if(K." <br /> PARENT PARCEL NUMB R: CURREN NING: ACREAGE Ievation of property <br /> El PARCEL / sI frontage drawn to scale.•NUMB <br /> TOWNSH SEC N: �}��j r/-- <br /> 1 l C 1//4./4 N 1�1/: 9• lid Driveway permi <br /> `� (state count ,town <br /> AD ESS: �Q� , �- / <br /> ` ��^' "' d r O Q li l Sanitary permits 2 0/G <br /> CSM: LOT .:D�ISi∎ BLOCK/'T (public,private) <br /> erg PROPOSED PROJECT INFORMATION S___r..- I /S7 <br /> PROD T DESC PTION: <br /> gIp /� r <br /> 4w ��...?4" ri.-4/7 •.► c 14 1 e r'-4. oning District <br /> . <br /> his project is a new building or structu -. t., 00 f ? v"i <br /> �S � i�� ► -rmrtted Use. ��- /�r <br /> ❑This project is an addition/alteration to an - isting building or structure. / la t / j <br /> SANITARY SERVICE: PER B �' A r�4 R 'ddreSS '/ems 4i <br /> 9) G:/�- <br /> [ EWER �3EPTIC 3 .• • -xistin ` <br /> HEIGHT INiEET NUMBER OF STORIES: (Not including basement) <br /> / ,e i -. --• loodplain/ 0 <br /> l horelan•, (attachmen <br /> 77 y g AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)ge- !=• ErosionControl permit <br /> BASEMTr y 1ST FLOG <br /> �rf I _ p 4, TOTAL SQUARE FOOTAGE: 4, •,p./eS,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) <br /> °=' Review Location Surve ay <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ A�f d available options. / <br /> (Please round to nearest dollar) $ /if SP/we i p� <br /> r <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? OYes F o ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? lilies 2No ElDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ,[ es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Eyes ,11\lo <br /> 5. Is this project associated with a rezone/CIJP ': • - •etition/appeal# ) (leave blank if none) y77�( <br /> 6. Is a location survey required? (see reverse).. �+.� Yes ENo QDon't�Cnow <br /> 7. Is this to correct a violation? .... QYes "lo ZS_I <br /> �J 240 APPLICATION MUST BE SIGNED <br /> ci,,) <br /> (Continue on Back) -+ <br /> 545-112(4/08) <br />