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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 /> A `. it%II 6 is co, El Zoning S tus;CUP; <br /> OWNER ADDRESS (Number,Street,Ci State,Zip) a De striction; CSM <br /> tOd� U.S I4W la* I i ,c-titict W= S3 Z31 vari ce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (p0'8'En -18 11 4o09'Sl3" "U D14&'■. lotto A Ak •wt ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 'q I bISe1•. ❑Site Ian i uding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of we s tic <br /> _ I065 b LS Uwt Iz- l <br /> (City,State,Zip) (City,State,Zip) El Setl�ap ' <br /> k <br /> beee44641 WS S5521 <br /> �v <br /> PHONE PHONE ❑Site Plaglaylp val from <br /> toot- 513-7$11 applica . <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> O 10 0 , _. .:1_ ❑Floor plak..iscale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: ('/� CURRENT ZONING: ACREAGE: ❑Elevati tan • •roperty <br /> ❑NUMBER 011 Z-Z3�-SSSo.t Tttz S,89 3 frontal= :yawn to scale. <br /> TOWNSHIP: SECTION: 1 1 1 ❑Driveway p <br /> 'pee , Z 3 /.: vW /4/4: SE (state,coun town) <br /> ADDRESS: <br /> CSM: LOT SUBDIVISION BLOCK/LOT ID Sani ml <br /> (pu c, Iv te) ` f / <br /> t <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> We- S h ❑ Zoning District <br /> . ['This 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 FIEPTIC (new/existing) <br /> HEIGHT IN FEET: <br /> kliei j l NUMBER OF STORIES: (Not including basement) <br /> 1 ❑ Wetland/Floodplain/ <br /> 2EATO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: I—, ErosionControl permit <br /> (GOOD + TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> G°o° <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ �j , oa and available options. <br /> (Please round to nearest dollar) peCi <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies YIN() ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes slo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes OW <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes [K .Jo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave bla k'f none) <br /> 6. Is a location survey required? (see reverse) ❑Yes j"V ['Don't know <br /> 7. Is this to correct a violation? ❑Yes 2tlo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -+ -, <br /> 545-112(4/08) <br />