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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to wen•App IS <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> NER ':ME <br /> _ v Zoning Status: CUP <br /> v c' NCcer S <<y. zr, Deed Restriction: CSM <br /> 'l <br /> ��� .uC�. 1 Variance(# <br /> ▪:' .'E PO EC LL PHONE E-M DRESS <br /> It. • te` r i� iCA Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> -NAME. 'Ct3atOR 11v-_ -_-.- YM1\` \�[`^--�/. . Site Plan including location <br /> ▪ T CON R• T e sDDRESS, of well/septic <br /> a e Setbacks <br /> 1�0 43— P oNE 57 L Site Plan approval from <br /> applicable township. <br /> li :E � MHi ERE p <br /> `�� Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLus/) <br /> P..RENT PrPCEL NUMBER CURRENT ZONING -CREAcE Elevation of property <br /> PARCEL frontage drawn to scale. <br /> NUMEEP <br /> V . r sE 'IJ'q <br /> ,�.eW 1_ r 'i:a: 1/1/. <br /> gib <br /> 4,a Driveway permits <br /> (state. town) <br /> ib 1111P <br /> T^,^ oT SURE LION R K C� Sanitary permits <br /> L <br /> (public. private) <br /> PROPOSED PROJFCT INFORMATION STAFF REVIEW <br /> PRCJEUT .ESCRIP IOr$ <br /> \-3 U ` a sO 1`, \,e` Li Zoning District <br /> X This project is a new building or structure. <br /> Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> . .: SE .1_E PER;_NJr,EEP) <br /> J Rural Address <br /> E VER r nTic (new/existing) <br /> � .J Wetland/Floodplaini <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT <br /> ,Outside dimensions including unfinished area attached ca and abo,ie grade decks or porches) <br /> � �. T F:CJ , . ; J ErosionControl permit <br /> TOTAL SQUARE FOOTAGE: (slopes, disturbance, <br /> ,.. SRC _" .p <br /> tj filling/access) <br /> -70 Yom+ e <br /> --_ J Review Location Survey <br /> I ESTIMATED CONSTRUCTION COST)Please $ a�,(OQJ and available options. <br /> round to nearest dollar <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 XNo Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? XYes 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) Yes No Don't know <br /> 7. Is this to correct a violation'? Yes X'No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br />