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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> w <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> tUf t,_ � . •-• . __ • Al ■ a r [Zoning Status;CUP; /� <br /> o " R f:' a Deed Restriction;CSM <br /> r A. 11`il CL' C -q variance(# ) <br /> HOME PHONE CAL P • ! g^ E-MAIL•,..ESS r <br /> Y4-: 5 b , ,; _ 1 l !�.1,t^ t.b 1 1. • d ® ['Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and indudes dimensions 0 <br /> AGENT NAME CTOR ( <br /> DtfrillA <br /> •Q,In ii 7 a tirisel. Elite Plan including location <br /> AGENT ADDRESS CONTRA CT< ' q .,.., o well/septic <br /> a.._91 � 6 <br /> 3 f 3 o/2 s/�/�v <br /> (car.stale.Zp) Setbacks <br /> ITT NYO l # - 1 o� LL <br /> PHONE PHONE [�'S_de Plan approval from Ai� <br /> ek 8-1/3,-9g%. <br /> applicable township. <br /> E-MAIL ADDRESS 1••- SS ii, . , <br /> 41,k otogr plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:'/accessdane.co.dane.wi.usr) [.�Elevationofproperty <br /> n�TPARENT PARCEL NUMBE-4 Q , CURRENT ZONING: ACREAGE: <br /> lax= - at —c o /—O fl-- I ( 75 frontage drawn to scale <br /> NUMBER <br /> cTION: �C <br /> SfixiNs)(11�( t`l ' , 121/Driveway perm <br /> I �. �4�4. <br /> ss• <br /> (state,county, <br /> ,,,,, 0/ 11 , AB .r 535 dsanitary , <br /> (public, <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> • I t�ad- <br /> e • ®h � ti` 4 Zoning District A- 1 is project is a new building or structu . tirPermitted Use? S c it <br /> _ <br /> OThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> Add si I l 3 — Z �' r 0 w 3 exsbn <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not inducing basement) <br /> / g' I Oattac n/ /� <br /> AREA TO NEAREST SQUARE FOOT: f (attadTment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) �y ECoMrol permit �� <br /> • BA a 1ST FLOOR: V� <br /> u j TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> Flood: ,/fitling/access) ,p p f <br /> 9 /V IiI�-Review Location Survey A I/ <br /> ESTIMATED CONSTRUCTION COST: ♦ _r .p and available options. •�^i�- <br /> (Please round to nearest dollar) Do/CY) h <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? [Yes o �on'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 (klo <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) Oyes ■:. • Don't know <br /> 7. Is this to correct a violation? QYes o <br /> l �4 <br /> G D A� APPLICATION MUST BE SIGNED <br /> 54Stt2( / / Z ✓ / �0 G 4, ✓ (Continue on Back) -► -► -►4.„. <br /> ZIC. iec.k 31 � �� -z <br /> 1 ' CO 1I r .r r z•" <br /> /Z � Ai7Z _ -- <br /> z <br /> , i 4' / S � <br />