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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 /> �L��� ❑Zoning Status;CUP; <br /> RADD SS (Number,Street,City,State,Zip) <br /> ne( iction, CSM <br /> 48357S. 1. V/E'N vial -f M, f VEX ' '4 w/ _s----...75_s----...75-2..? Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ,, „ _ .1 .Aw _ II a 1 .c ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME ��.,,� � //�'� CONTRACTOR NAME <br /> Co P9g /� Ire' (a tit X.0 QwC �-n�-- ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> Y ? O SSac /Z pc.). a / Z <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> /vlt, /7 O to s"33 7Z /'mot /7 4 &/ S3 72 <br /> PHONE ( PHONE ❑Site Plan approval from <br /> 6 a - 77 Q _3 77Y to c I_ 7 g r _ 3 >7y applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 111 Floor plans to scale <br /> c) -/ L ., i et ' 6., i ' • W C' — 1 hi l l • L" <br /> PROPERTY/LOCATION INFCRMATION (http://accessdane.co.dane.wi.usn ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER �j6D�-D 2'Z 733 S 4--/ , r=-7 ,,qc frontage drawn to scale. <br /> TOWNSHIP: SECTI N: <br /> S'P(Z)nj( DA a Z 0 %4: ch./ %/ : /1/14 ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 9)3 _5-' KL,E'V ✓/GL L. -(2l L�jy /Z' tg4 t rid/ 14-'/ S3.591 ❑Sanitary permits <br /> GSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> x,TG/ t- 3- - l') l°c-ec/ t C�i / J t,4 ❑ Zoning District <br /> . ['This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER T EPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> /3/ / LI 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: 1ST FLOOR: .�/ 1-1 ErosionControl permit <br /> cm .[ 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: L :7- filling/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST available options. <br /> (Please round to nearest dollar) ♦ ♦ -► --► -∎ ♦ E 000 , .G <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes jNo ODon'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? Efres ❑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 ao ['Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -to ■ -* <br /> 545-112(4/08) <br />