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NC-6-4-• 4 >-5-7-SO 6-', <br /> (- 9Q i aC <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER.INFORMATION - CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 1� J +,/ pp <br /> Y 4 m U L7 <br /> QQ oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> M 3s` QO ` L� `jj S i U I r 013 3 .i Variance(# <br /> ) <br /> HOME PHONE CELL E-MAIL ADDRESS <br /> �3 -01 9! ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION wand includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE Nite P n royal from <br /> cab. township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ig Flooiplans to scale <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi.us/) Q elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL c ) y `3 14 ,)OS f, n frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: 0 S TION: <br /> 0 t._;,e) V'1 — 1�. -1/41�: J Ivew rm its <br /> ADDRESS: I (slate nty,town) <br /> -3) B/ Q k_/ n SUBDIVISION� BLOCK/LOT yt'I Sanl its <br /> CSM: LOT <br /> PA// (publ ate)Sib <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: � <br /> 0-o Y 2- i- f` v 62_ g_ti ❑ Zoning District <br /> ❑This project is a new building or structure. <br /> ❑ Permitted Use <br /> This project is an addition/alteration to an existing building or structure. • <br /> SANITARY SERVICE: PERMIT�NU/MB Li Rural Address <br /> SEWER ❑SEPTIC I � (new/existing) <br /> HEIGHT IN FEET: 1 ` 4.. NUMBER OF STORIES: (Not including basement) <br /> l/II T ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> = <br /> BASEMENT: 1ST FLOOR: i ErosionControl permit <br /> f C ,+, TOTAL SQUARE FOOTAGE: ,,, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: tlilinglaCCBSS) <br /> ®'Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: QQ�� and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ "i ♦ $ S) CI 00 , <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 'Q No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? gYes b No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? L 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 /> (Continue on Back) -i • -9 <br /> 545-112(4/08) <br />