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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 /> EaL a• 3 6v -00/•/ Ni Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip)4 <br /> ZOOS 9 "( I.:SNE —IvE Deed Restriction;CSM <br /> HOME PHONE CELL PHONE Variance(# ) <br /> E-MAIL ADDRESS <br /> f , @ •ono,,i .CCU Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME 5 N 3 � CONTRA:OR NA <br /> J\NMI. N A 1 V J VG i V/C - foppic Site Plan including location <br /> 'AG ''�.ADDRESS , �yto1 CONTR C R ADDRESS of well/septic <br /> T�1 `�t,-CbN 51- <br /> (Ci State,Zip) (City,State,Zip) <br /> 511Na aJ I W i 5 3 S 1 <br /> Setbacks <br /> PHON J PHONE Site Plan approval from <br /> ���" 5 applicable township. <br /> E-MAIL ADDRESS ��>> E-MAIL ADDRESS <br /> • <br /> W�1�rGS ik..u` , t1 • con Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: GT CURRENT ZONING: ACREAGE: Elevation of property <br /> PARCEL 0 NUMBER Q,1-19a-�JIJ1S"1 �' 0. I Q frontage drawn to scale. <br /> t <br /> TOWNSHIP: _ SECTION: <br /> -Too N ∎\tr g...9 Ys: S 1&) %%: N W E Driveway permits <br /> ADDRESS: `' ` (state,county,town) <br /> Zoos 5~y G ', 5� -1 Nt W'. s Sanitary permits <br /> CSM: LOT SUBDIVISION T <br /> OS Soo _ BLOCK/LO (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: p <br /> S i 1r1 C\e- YCL.t�k'\ .‘ 'C\t'S (,Q, oning District <br /> This project is a new building or structure. P fitted Use? <br /> 0This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: DEPTIC <br /> PERMIT NUMBER: �p • • a I Address <br /> EWER t PEPTICY��\_ �_ 1 "U (ne 4000,.HEIGHT IN FEET: `J NUMBER OF SrTOORIES: (Not inncludii`ngg baatj�� /► r' _ <br /> .2� oa.. `V1�IX�A���tlan sr ••'plain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) �� 7q <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) > Ci n3 C <br /> BASEMENT: 1ST FLOOR: k {t� Its <br /> 1 D I Z,5 +, TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR ± 3RD FLOOR: <br /> O((zJ AI A 3(0 fill�r�� ss) <br /> eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ Q CO and available option <br /> (Please round to nearest dollar) s 1, 5 a , <br /> yS- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? fires ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Z1 es ONo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? '` es No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? III es 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) 1Yes No ['Don't know <br /> 7. Is this to correct a violation? Eyes �No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ -♦ <br />