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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 /> I1/}R.K B— ,vas 016/A- EftffivfS, - --vc. . ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> ' Deed nction; CSM <br /> 6 '/3 NE-s6i f kg 1h/-D1solu, A-1:71- S 3 ��9 Variance <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> g 3 -0 y-5- ❑ Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> to (fir-;y CON5172.14.0 7 ?&/ c Co / f-,--y Cdn,s T, =-r e____ <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDdESS of well/septic <br /> /03 ,x'//c s-r 4-,v /d 36 I.//71c/2 CST- <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> °'66,0,U (v 7 S C 2 5 O/ t ,OA/ iU7 s S 7 ''. <br /> PHONE PHONE ❑ Site Plan approval from <br /> 6 U d K35 '9 go / 6 0$ e73.5. 7 BSc etQ( .2/2 t z v applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Ve(Cie 4-7.‘cru IL 6i.' <br /> t.) C/. t U4/1 . v44,L f-,one A as/. e tw' Li Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> Li PARCEL 1/0 - �� 9���_ /7 frontage drawn to scale. <br /> NUMBER G <br /> TOWNSHIP: SECTION: <br /> rU w/! o-f 6 iktuct, / 1/4: s %/4I/4_ ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> (3'"/5" ic r«,€,c di) sc.LN 4441.g),G w1I 5 3 -N 7v • ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 5/1/t S rp%4 6 E 'E S �90( O 35 7 ❑ Zoning District <br /> . This project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: ri///q PERMIT NUMBER: LI Rural Address <br /> ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> cz2/ i /6 3k r 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: I-1 ErosionControl permit <br /> 3gy o + TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 3g c <br /> LI Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ Q vl� CCU 00 and available options. <br /> (Please round to nearest dollar) �V <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes allo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 21 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? W Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes LNo <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 50 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i ■ -+ <br /> 545-112(4/08) <br />