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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME / Q <br /> / Zoning Status; CUP; lam- Z <br /> OWNER ADDRESS (Number,Stree,C State,Zip) Deed Restriction; CSM <br /> 331-5 LS -�JC L,?.� p . 1. Variance(# <br /> )/1161 <br /> HOME PHONE CELL/PHONE E-MAIL ADDRESS <br /> G 01_).3 7 94 1 D Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NNAA <br /> /CiQr,r /d� Zs/k/- e/o El Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 'e D God -7:o/L 6,e./v E <br /> (City,State,Zip) (City,State,Zip) Vi Setbacks <br /> /v'AClidk) tJT 53 7° <br /> PHONE <br /> PHONE 'ite Plan approval from <br /> 60? 01'0 oF3( applicable township. „✓/�1 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> !�t <br /> MI Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: 7 ACREAGE: P p y <br /> Q NUMBER D//V -352 r ell' -- (o e` , 3 3 2 frontage drawn to scale. <br /> TOWNSHIP: n e J 1 SECTION:/ %: ,,/L %%: w/ W/ 'IJCI Driveway permi <br /> ADDRESS: !yJ` 2 5 /V /{/ vl/ •G�(state,county, • + <br /> San' .ry permits <br /> CSM: LOT / SUBDIVISION / BLOCK/LOTD <br /> ,--- 2) A - /-,/ ft.. // -I st/idifl (- bli private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DE CRIPTION: / / / <br /> /( //16(� 9- I&PL.locE , o jr Cre�, 6 X a ,1 / %Zoning District Z / P7 <br /> -JThis project is a new building or structure. VO V- F v ��- �A w <br /> y 04 y�f Permitted Use? � <br /> QThis project is an addition/alteration to an existing building or structure. / <br /> SANITARY SERVI : PERMIT NUMBER: Rural A,• G' <br /> EWER PEPTIC (new/ stl • <br /> HEIGHT IN FE T NUMBER OF STORIES: (Not including basement) <br /> / 621W: I -• >• Floodplain! 0 r <br /> AREA NEAREST SQUARE FOOT: <br /> • _ - (attachment <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: / / ion#ontroipermit <br /> / y + TOTAL SQUARE FOOTAGE: j (slopes,disturbance,To / <br /> 2ND FLOOR: 3RD FLOOR: (((yyy l ` filling/access) A y / <br /> �'41 YQ` fT CReview Location Survey / <br /> ESTIMATED CONSTRUCTION COST: 5 0 0 r />� op <br /> (Please round to nearest dollar) <br /> '� '♦ '► -� -► l/ and available options. ►4/ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes o ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? DYes No DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es 9 Jo <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) Dyes to ['Don't know <br /> 7. Is this to correct a violation? DYes o <br /> 5 L/ FD APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -∎ -* -► <br />