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ZONING PERMIT APPLICATION www.countyofdane.com StlPPLEMENT#o:wi:b App <br /> :PROPERTY.OWNER INFORMATION <br /> . ' � �'.''�-,-_:'� CUSTOMER TO PROVIDE <br /> OWNER NAM ,�/ L <br /> -e °( �" c ,gQ//�e/ - n Zoning Status; CUP; <br /> OVVI� te CSM <br /> 4DRESS (NumbreetHjWSta 6'6/ -. /Yo / )ct el '"I l 1414 -S3S7� <br /> Variance(# ) <br /> ME PHONE LL PE / E-MAI •*DRESS <br /> (ooY' .3 - i36 4 A-rA 9-4" al�1r/ P hgor�-Q C oh) <br /> Site Plan drawn to scale <br /> AGENT INFORMATION . CONTRACTOR HTIFORMATION ; ;1.f` <br /> ,,.� and includes dimensions <br /> ' AGENT NAME CONTRACTOR NAME <br /> 0 Site Plan including location <br /> AGENTADDRESS 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 /> Floor plans to scale <br /> ;PROPERTY/LOCATION`INFORMA_TION (httpi//accessdane C_o"dane wi u4v ,_m, Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ONING: ACREAGE: Li <br /> PARCEL --c7 drawn to scale. <br /> NUMBER a `70 G 4f�_ /-.�- `2— fronts/ ? e,Cke s'- g <br /> TO HIP: SECTION: <br /> Vt L Ly)a LI* 5/ %4: 1/41/4: ❑Driveway permits <br /> ADDRESS: <br /> Q��/ // �'}� � (state,county,town) <br /> // /44o4i-1/P' J i'i✓ Hb4) . ,s---7,2 El Sanitary permits <br /> CSM: Loft• SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION _j STAFF;REVIEW <br /> PROJECT DElSC IIPTION: / x s <br /> .''6 /?i-h s7ri- ,Z-(40--0-.in Zornng Dlstnct , <br /> ❑This project is a new building or structure. - � Y �,4, - 'x <br /> Permitted Use? <- <br /> VThis project is an addition/alteration to an existing building or structure. i � -� x F li:, _ . <br /> SANITARY SERVICE: PERMIT NUMBER: a RufarAddesS';z <br /> [EWER {EPTIC It n"`(nwwexlStthg) T Ti <br /> ,r. <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) = S s _ <br /> A 0 _ :❑ Wetland/Floodpjainn/ <br /> * Shoreland(a'ttach ent) --i <br /> AREA TO NEAREST SQUARE FOOT - ,. - <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) p .- r <br /> BASEMENT: , 1STFL0 FLOOR: <br /> :® Erosion Controfpyeryrnit <br /> 9 / C 4, TOTAL SQUARE FOOTAGE: j .slopes dlSturbance <br /> ��x..� '=y'�rs. <br /> 2ND FLOOR 3RD FLOOR: //� G f(IIIr1g7aCCeSS):74 <br /> 1. t�evlew2_Locat191 Survey <br /> ESTIMATED CONSTRUCTION COST: " � / � o� and aa llb e opttonS4 <br /> (Please round to nearest dollar) . , -.pr 4 � <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Des ONNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes alo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ Yes QNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - Lives [ENo <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) Efres alo Don't know <br /> 7. Is this to correct a violation? QYes NINo <br /> Zorn, , 0310 <br /> / f APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4 -4 -4 <br /> 545-112(4)08) . <br />