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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> CA/ ,..-5-C.CL(e Cermpcwtv ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,ZipO Deed Restriction; CSM <br /> -/5 5/er/i t,.1 ,,t✓e Po 00K 636, IAAJC e TA 52 273 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 3.-4e 5'266 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> KL Al- d�e41:5€-vl o W me r— Lut td e r CI Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 50.444e ea.5 ci>ja LiQ <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> • PHONE PHONE ❑ Site Plan approval from <br /> 63- 1(6A -.,5 c)c applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usi) <br /> PARENT PARCEL NUMBER: CURRENT <br /> { CURRENTZONII7NG: ACREAGE: ❑ Elevation of property PARCEL❑ NUMBER OW/ 0 ( ( Q C,6 U Lt �C V3;� frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> P(easc..,,, '5?f-( 0 9 1/4: 1/41/4: 1:1 Driveway permits <br /> ADDRESS: I (state,county,town) <br /> ;g7H, `,, /41 N CI Sanitary permits <br /> CSM: Loft SUBDIVISION BLOCK/LOT <br /> /0(,03 y / (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> .s,4.l4 x6/77 se/'44 i-r • c-4 5e-ar'e; uiti't sl/m D Zoning District <br /> . ®This project is a new building or structure. <br /> U Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> N/ ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> � c� / ac�c% �avP�te.vr�4e 4,-, Ar/A ❑ Wetland/Floodplain/ <br /> J / AREA TO NEAIkEST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> ErosionControl permit <br /> 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: rj,_-,;. 2200. filling/access) <br /> S'9`'k /06 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -► ♦ ♦ ♦ 5[d(r 7�/ &'O and available options. <br /> (Please round to nearest dollar) $T i9 i1 e, Q^70 <br /> .60 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 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? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► —► <br />