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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 /> }� ,0 BBEgs dl--R-04,0 USA 'GZ'zoning Status; CUP; <br /> OWNER ADDRESS (Number,SS_ttrreet,City,State,Zip) ��/'�j Deed Restriction; CSM /IS <br /> HOME 9aI sv CELL PHONE AILADD i �1 5_3 7 1-s Variance(# ) <br /> NI Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions 4 <br /> AGENT NAME CONTRACTOR NAME /CO <br /> F 'j SIAS kV 3)( 01, Site Plan including location I <br /> AGENT ADDRESS CONTRACTOR ADD ESS of well/septic <br /> ,40/01 0__J -1 - <br /> (City,State,Zip) (City,State,Zip) [Setbacks ,515— <br /> W11.t Sod to I 5.5'119 <br /> PHONE PHONE I Site Plan approval from ,,/ <br /> 1 19 _0974 _ 444 applicable township. /" 4 <br /> E-MAILADDRESS E- AILA�DRE-S� -�Pf, <br /> 0. , ` 4-454 Floor plans to scale (/� <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property " 0 <br /> PARENT PARCEL NUMBER: y CURRENT ZONING: ACREAGE: <br /> ❑P PARCEL <br /> ER 02001_3 5 -- ? gO-5' C — 2 Z 2 frontage drawn to scale. <br /> TOWNSHIP: SECTION KR <br /> li t S C 3 S '/a: -S bJ 1/1/4: A) iv Driveway permits <br /> ADDRESS: .` (state,county, ow <br /> e9 024 SVrNE 7, MAJI��1 wR c5-7i3 E.Sa ' - permits <br /> C M: LOT SUBDIVISION BLOCK/LOT <br /> �� is blf private) <br /> PROPOSED PROJECT INFORMATION 'STAFF REVIEW G 2..-- <br /> PROJECT/ SC N:s J f I <br /> t 12 r () 1( 20 WA 1 I o^y nmDistric t <br /> -, r <br /> ��eri g <br /> ❑This project is a new building or structure. $ 0 4,-+� PermtttedyUse�. ..�� <br /> his project is an addition/alteration to an existing building or structure. fi 3 <br /> SANITARY SERVI E: PERMIT NUMBER: RUrai Ad SS <br /> EWER [EPTIC - (ne <br /> HEIGHT IN F ET: 1 NUMBER OF STORIES: (Not including basement) <br /> t ,Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) y; ErosionControl permit <br /> BASEMENT: 1ST FLOOR: / r� I TOTAL SQUARE FOOTAGE: I (slopes,disturbance, T D <br /> (/ `J filling/access) 4 • , <br /> 2ND FLOOR: 3RD FLOOR: !OD <br /> ( Review Location Survey' <br /> ESTIMATED CONSTRUCTION COST: $ I 3519 ,' and available options. <br /> r <br /> (Please round to nearest dollar) Tw <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes gNo EDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes glo ['Don'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? Des 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 ❑N E✓Don't know <br /> 7. Is this to correct a violation? [—Yes 21vo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) _ _ _ <br /> 545-112(4/08) <br />