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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> ..0^IER NA E <br /> . 64kCI u k t F.. 1 ∎`e Xoav, et'ey ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,qtreet,City,State,Zip). Deed Restriction;CSM <br /> 7 4 . / 0 V R Cj Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS 1 <br /> — ; 0 i % 5 `-'“r . a ca 't, v U.e. Co m • N t tV ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME • GO'W <br /> (k vo. a C. 0- 19 D ✓'c- S fL 0.4 6.-4,d V L ❑Site Plan including location <br /> AGENT ADDRESS 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 INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> ❑NUMBER O eO I 0 (71 Q o oo-3 A_ FY A-'1 s O frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> `D 7 1/4: ft %%: s 0 ❑Driveway permits <br /> (state,county,town) <br /> ADDRESS: <br /> C CV/kg a S o.b O V e- ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ❑ Zoning District <br /> . )2`fhis 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 rEPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> oZ --I / l ❑ 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: ❑ ErosionControl permit <br /> / <br /> !/ / . (/' ,, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 3 'Y T filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> it r' l° ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: D h and available options. <br /> Please round to nearest dollar -I. -11. --0. <br /> 00 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Ii No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ©Yes Elo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Ores ❑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 /❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 121iVo <br /> y3L APPLICATION MUST BE SIGNED <br /> 545-112(4/08) ✓ <br /> Zl (0L\ 5c1 4 (Continue on Back) -► <br />