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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> 1a C-rr\q,∎ k- A C-rn'Ls L L <br /> ❑Zoning Status; CUP; <br /> OWNE ADDRESS (Number,Street,City,State,Zip) M n ' Deed Restriction; CSM <br /> �� (��a �P_1 e� i I' t4A■S c51n1 53 ` t� Variance(# ) <br /> HOME PHONE CELL PHONE VIAL ADDRESS <br /> Ngr- -e...r\• ( -1® q.kre. ' ❑Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMAL ION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> �Q rn t— ck S c\-I0.(p v � ❑Site Plan including location <br /> AGENT ADDRESS �CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> PARCEL �j frontage drawn to scale. <br /> NUMBER Oct 2 o s it,SE 33 0 t ,r <br /> TOWNSHIP: SECTION: <br /> '/4: '/a'/4: ❑Driveway permits <br /> A �'�Y` 1 (state,county,town) <br /> A DR SS: — f ,� 1 <br /> i/ 9 � t W o V Sanitary LOT SUBDIVISION' BLOCK/LOT 1:1 ry permits <br /> 3 13I eszay...,L1-2(.s (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 5 i ' t:. t-r- <br /> rn'.` (Rer1M ❑ Zoning District <br /> . g=This project is a new buildind 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 *EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> V t ' ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <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 /> ErosionControl permit <br /> c t i r-t� j- 3 1 5-"f 4, TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> �-f 3 l filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 57 S-^ <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -�► -�► ♦ ♦ l and available options. <br /> (Please round to nearest dollar) •Poi 30 oto_00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [ to ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? :Yes o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Nfres "lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes E to <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 /1 o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 'j o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -4. <br />