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ZONING PERMIT APPLICATION www.countyofdane.colll supPLEMENT#01Neb App;#'. <br /> ;PROPERTY OWNER_INFORMATIOINz_ w 4V- r , S t -, gfr. CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> SG,0-tt (./i,,ti 1 !Zoning Status;CUP; <br /> OWNER ADDRESS plumber,Street,City,State,Zip) Deed Restriction;CSM <br /> (201 /- cvr,1 Gf-. iDeer ; -Id j i-Irr 53 5 3 1 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (aog.351-1.055 5e- caq®•ima.�.(,01-1., ❑Site Plan drawn to scale <br /> 44{�1-fi-�l.t f' <br /> AGENT:INFORMATION_ `.CONTRACTOR INFORMATION tM, s-- .D,_� and includes dimensions <br /> ' AGENT NAME CONTRACTOR NAME <br /> ❑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 INFORM ATION '(http/laccessidaipe co_iiane w41.6)- '_ <br /> PARENT PARCEL NUMBER: �y CURRENT ZONING: ACREAG : ❑Elevation of property <br /> ❑NUMBER O/%-Yen G ZOZ�7S 0/12(2g. R it-i 5• ).5 3 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Deere fir Zo %4: WA: ❑Driveway permits <br /> (state,county,town) <br /> ADDR t20\ / F� r i <br /> C-+ Deee I4 53571 ❑Sanitary permits <br /> CSM: • LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION --' -R <br /> - ., -- - '� STAFF REVIEW <br /> PROJECT DESCRIPTI N: "+ ' <br /> 5t tJ Zoning Dlstnct u` " <br /> This project is a new building or structure. 7 ��' `h <br /> M Pet lttg Ue?, . f r <br /> This project is an addition/alteration to an existing building or structure. <br /> x r <br /> K <br /> SANITARY SERVICE: PERMIT NUMBER: ® R I Addre S�{�{ r <br /> ne :exls r :� 3 <br /> EWER EPTIC � y.' ,r..,.,*9 4 � _ <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) � � <br /> /8 (_ y ❑ Wetland/Floodpjaln)� .. <br /> (7 / Shoreland;(attachment)*?: <br /> AREA TO NEAREST SQUARE FOOT f ,� <br /> (Outside dimensions including unfinished area attached garages arid above grade decks or porches) ¢ <br /> _❑ ErosionControl permit,? <br /> BASEMENT 1STFLOOf r <br /> Z (� ,, TOTAL SQUARE FOOTAGE: 4, CSlopeS ilsturbance <br /> M <br /> filling"7access) <br /> 2ND FLOOR: 3RD FLOOR: I ,, f O Z,LLd W 4 _I <br /> "�FLGrf� ��} �� ��.� , <br /> ESTIMATED CONSTRUCTION COST: ❑ 0evlew�L oeatlon Survey <br /> 210149620 i and available options <br /> (Please round to nearest dollar) "� "0- '♦ --0- —0- "0. $ - F f'3 :,W <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes `r o ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ri o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ,Wes 111 o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - Lives jNo <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 C/1 o ❑Don't know <br /> 7. Is this to correct a violation? [Yes !' o <br /> Lt l'° APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► -+ <br /> 545-112(4)06) <br />