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ZONING PERMIT APPLICATION www.countyofdane.com st1PPLEMEN7_tO.Web App.$'. <br /> PROPERTrOWNER'INFORMATION z „_,,., , ,0 `'. CUSTOMER TO PROVIDE <br /> OWNE�ME <br /> ...IG fr'--?■01/4.)+'tf_ <br /> n Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,C' ,State,Zip) Deed Restriction;CSM <br /> `7 41 .5t...,4lloi..;ip. le-.. are p r,N (,)i Variance(# ) <br /> HOME PHONE CELLrPHON� E-MAIL ADDRESS <br /> ,t, <br /> kt-t ®(Q D cv ❑Site Plan drawn to scale <br /> AGENT.INFO RMATION `CONTRAC <br /> *lit INFORMATION` ..,E , " and includes dimensions <br /> 'AGENT NAME (' CQ�TRACTOR NAME t. <br /> .pct\ lu r'\ t v%c.‘',vN Cu , 'o v.-1 [Awn) h Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> L.) 3Z3`46 D, ct a,1wc. nA tkO a___________ <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> kLvm'i th • - - 5- 1--1 <br /> PHONE PHONE ❑Site Plan approval from <br /> (y 040 6-7(,r C16 5 l.( _ - applicable township. <br /> E-MAIL ADDRESS E-MAIL A DRESS • <br /> CAN (,t1 iC) - vri(k;t.0 D�� ❑Floor plans to scale <br /> 'PROPERTY/LOCATION INFOI !fATION (httpi/laccessdane Coda ne w,use ❑Elevation of property <br /> PARENT PARCEL NUMBER: CU ING: _ <br /> ACREAGE: <br /> PARCEL .050°1-- la- <br /> Y / , frontage drawn to scale. <br /> ❑NUMBER 50.050°1-- Z7Z-L(C�/O1_r �- I A (�� <br /> TOWNSHIP: SE <br /> n �,--1 Z-7 %4: 1441/4: ❑Driveway permits <br /> •ADDRESS: J (state,county,town) <br /> ill% H t4.4- 2E5T t""j0"''e-. ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION . ,' - , '' ' '.1- -;.:-- STAFF'RE�/IEW f:; <br /> PROJECT DESCRIPTIO + , - > z '' " <br /> tw tk-6 y✓L- -, Zoning Dlsinct l <br /> EgChis project is a new building or structure. E'P ' k <br /> �� Pe�mitfed Ue? i <br /> ❑This project is an addition/alteration to an existing building or structure. - <br /> f <br /> SANITARY SERVICE: PERMIT NUMBER: ;`LI RUralAddr2SSt <br /> EWER [EPTIC .w `(new/exISting) _ T! <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> �� _D�Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT Shorelifili attachment) <br /> .s ! 4 <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ® s r = <br /> ErosionCo i%1 pe .11i <br /> BASEMENT: �,3I ' 1ST FLOOR: p v slopes �IStuprba"n <br /> ' Ce <br /> l l I 4, TOTAL SQUARE FOOTAGE: 4, <br /> 1 ilif§accss} <br /> 2ND FLOOR: 3RD FLOOR: �'��-w cal = 4 Y { Y <br /> 1Z 5� ��'�,, l 7,Revlew�LotatitiTS,t.trvey <br /> ESTIMATED CONSTRUCTION COST: ' } ' >r.�v-- <br /> �. and-avallabf�options <br /> (Please round to nearest dollar) -► --► '♦ --► --► -► � , 5:. '- r Y> z -.;;. <br /> wit 2 ,3 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes EINo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes a/o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑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 alo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -4 -I- <br /> 545-112(4/08) <br />