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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 /> t id J7" Ref/ TkI,iST <br /> Zoning Status;CUP; (r; <br /> OWNER ADDRESS (Number,Stre t,City,State,Zip) <br /> /77 i.- cv 2i // p,..��n a' 535-21 Deed Restriction; CSM 3 <br /> K Variance # <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS 1 <br /> - 8---.50 8---.50 S�__ etrite e I/44e4A)`v-e..,• net Site Plan drawn to scale <br /> AGENT INFORMATION I CUNTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> „J` ES voarx 3 D C.on SI'iru..r1--,r n 'Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS nn II of well/septic <br /> /77 &l) ,A,,,j e,( /v37Sr4, 6Oe ,41' / 3 7-- . <br /> 0I�, 0 0 <br /> (City,State,Zip) J (City,State,Zip) Setbacks � <br /> &66.111A I(AM X3521 Mon toe ICY.- _5356 lP <br /> PHONE PHONE ❑Site Plan approval from <br /> Qo'- 2? '- S O63 66 3 8 - 1`cia.8` applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> - wrtS Q_j 1-1-etAivic., /)e.+- Floor plans to scale ■ 9 <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property / 0 <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty / <br /> ❑PARCEL oC o i t/L/ k I4/ // 127 Trontage drawn to seal. <br /> NUMBER J ,, `> jJ V4.V f-� 7 /5� <br /> TOWNSHIP: SECTION: <br /> 0 P,. <br /> & ' / j'/-}.". 9 1/4: '/41A: Imo/ Driveway perm't. <br /> ADDRESS: 0 / state,coun tow ) <br /> 177 G/en IBC t4( j3j ] 1� l , (Al2- _.3 5-0/ f Sanita <br /> CSM:0 7a LO) / sub VISION BLOCK/LOT (publ' , rivate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEliTio <br /> PROJECT DESCRIPTION: + � ) �/ / f / / <br /> 'PbS R'a,p,t,L r s.LA%.'"\S `/ ) (p 3 l 0 'Zoning District H if <br /> This project is a new building o�'structure. S 4.0 v4 S c L-e--/ tif Permitted Use? g6 J / <br /> ❑This project is an addition/alteration to an existing building or structure. / I�t: pp d' 6'S <br /> SANITARY SERVICE: PERMIT NUMBER: rUral A s Sfe brct <br /> FIEWER PEPTIC (new <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) <br /> W= •• oodplain/ <br /> Shoreland -ttachment) '","ii' <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> rosionControl permit <br /> 3 b 2,-1 j TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, ( d / <br /> — I in. a. - �� / <br /> 2ND FLOOR: 3RD FLOOR: +O ■ <br /> S Air' Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ 4e and available options. <br /> (Please round to nearest dollar) 2�A 1..1C�, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes Alo Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 74 o Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes U o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes alo <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 ►�� o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 14 o F3SS <br /> 2 APPLICATION MUST BE SIGNED <br /> (� �� (Continue on Back) -► -► -► <br /> 545112(4/08) <br />