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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME L <br /> ��/`� +T �0V` ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State, ip) Deed Restriction; CSM <br /> Y% Cvuti um k_ K W arm4 kee col 53597 Variance(# ) <br /> HOME PHONE 1 CELL PHONE E-MAIL <br /> ADDRESS / <br /> 60$-Z37 (3 3� 608-sot-I ° e f'iaf1/b� @/w-1wial 1 , c0 ' ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> p Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT NING: ACREAGE: <br /> ❑PUR1 ER 6:k g Zs-Zq 6 B L°,r 3(o frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> ' ld ` <br /> s � vLt� � (~ 2 S '/4: Nit)�y '/<'/a: R�� ❑ Driveway permits <br /> ADDRESS: P t (state,county,town) <br /> 6ilq` Cauv c Th , W uvc ee, w1 G35g7 ❑Sanitary permits <br /> CSM: LOT f SUBDIVISION BLOCK/LOT <br /> O 3 ! (/ (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> C k c - 60019 p <br /> ❑ Zoning District <br /> . EfThis project is a new building or structure. Older. , 5044 Rev' coot' LI Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. Tvr✓� <br /> SANITARY SERVICE: �r PERMIT NUMBER: u(�(�eJ�i ❑ Rural Address <br /> FIEWER rEPTIC • V (new/existing) E <br /> HEIGHT IN FEET: y i 6 �t NUMBER OF STORIES: (Not including basement) <br /> 7 ❑ 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 /> BASEMENT: 1 ST FLOOR: ❑ <br /> ErosionControl permit <br /> / L/Q 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: c V u filling/access) <br /> r 0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: �j 1 and available options. <br /> (Please round to nearest dollar) -•► ♦ ♦ ♦ -•► ♦ $ .!, 3 0v • <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes 4No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes rj111 o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Nes /No CI4,'c . Clop `- <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? a es ❑No PO eV061t4 <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 /I o ❑Don't know <br /> 7. Is this to correct a violation? ['Yes )' o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />