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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C STOMER TO PROVIDE <br /> OWN R NAME <br /> ( J O(y\< \\r " .--( ( \ ' ∎-6 <br /> C-1 ZG \E V1 Zo .ng Status; CUP; <br /> OWNER ADDRESS Number,Street,City,State,Zip) <br /> `o:)F)q f _ Le eed Restriction; CSM ) <br /> ariance 64) H•ME'- ONE P O E F MAILADD' S <br /> , �/ 7t-d/ C co elib"95 1 " • 4 Site Plan drawn to sc le <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes di sions <br /> AGENT NAME CONTRACTOR NAME <br /> ", �\O \ Ski) ❑S" Pla • cluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f w septic <br /> 1035aCoup 6 q Lo-t- 7 <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> M625;11)0,11 t P,i (,c) i b ,0 <br /> PHONE PHONE S. Plan approval from <br /> (00X_q5 7_ COSSS pplicable township. <br /> E-MAIL ADDRESS ,$..E-MAIL ADDRESS <br /> M a man,' , r k m " loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT Z ING: ACREAGE: Elevation of property <br /> ElPARCEL PARCEL o? -&Qj.?6/O-Q ^ ( /3 frontage drawn to sc . <br /> NUMBER o? o v <br /> TOWNSHIP: SECTIR 1(� I <br /> M C b m can\ �. , u�-c- O� V 1/4: M '/4'/4. V v ❑Driveway its <br /> ADDRESS: (State, unty,tow• <br /> 1035'i Cd o n-kt I ) L....0 / 10 in G zo m caN I e, LL)X 53560 <br /> CSM: L6T i ' BDIVISION BLOCK/LOT ❑Sanitary p= its <br /> SPA 1 CP ` 0n, (pu•lic •rivate) <br /> OA <br /> PROPOSED PROJECT INFORMATION -TAFF REVIEW <br /> PROJECT DESCRIPTION: (4.1 <br /> e 'Y\t-PC1--- 0 ,./,C ■ .O ' g District <br /> . <br /> This project is new build) g or structure. 0 ermitted Use? <br /> This project• an addition/alteration to an existing building or struct re. <br /> SANITARY SERVIC : PERMIT NUMBER: ral Address <br /> EWER 1)EPTIC ew/existing) <br /> HEIGHT IN FEET: ��/ NUMBER OF STORES: (Not including basement) <br /> �_�l�i, f We nd/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Sh reland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) rosionControl permit <br /> BASEMENT: 1ST FLOOR: %c) I co <br /> + TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: I I1 1 filling/access) „ , <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ �� © ^'� and available options. \ j <br /> (Please round to nearest dollar) U <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Eyes INo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? JYes ONo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes No <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) Elves giNo QDon't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -∎ <br /> 545-112(4/08) <br />