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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App N <br /> 1 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> IER 114,1,1 <br /> M Lola 5 5 J Q hie5DY\ ❑ Zoning Status. CUP: <br /> C.',11 F-LLFECs Iluml-eI tr-t..:it, -t;t=._il: Deed Restriction: CSM <br /> ��� 5 � � � 5� -8 Variance i# ) <br /> HGI,IE FH")HE OG _E L FHS:I IE .- ?'IL:.CCFE�S <br /> Gob- 87T-8�C/ 776' o'yy �Ii.21 ' • • i` s 01 - 6 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> 4,GEIITti rl CIITR TmRII i1E <br /> � ¢ mA- ❑ Site Plan including location <br /> 4;E1 IT DEPEvF I rITR=cTCF -CCFE of well/septic <br /> ca, :-.tat= -ir. It :tot‘ Th1 - ❑ Setbacks <br /> FH.IIE F'H 11E ❑ Site Plan approval from <br /> applicable township. <br /> E-1,1-IL-COPE" E-1.1-IL-C'C,FE'. - <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> F-FEIIT P“R• ELtllR;1EER r'F. 'ElIT,C4111I':T, L.,-FE%-7E ❑ Elevation of property <br /> ❑ iIL�,ie,EF: 6C//-013 - 950)-O 'l1- F,� �S o ) C g frontage drawn to scale. <br /> T '.'.1ICHIP SE,_TI Tit <br /> (w r\h I.r i 5 E ,a: ,;. ❑ Driveway permits <br /> (state. county.town) <br /> CCREF� ty <br /> 4 05r c( ❑ Sanitary permits <br /> 2�r.1 �� 1,.T �FCI I-�il 1eL hL_T public. privatei <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PP.,,IETT L ES:PIFTi7I I: I �\, <br /> J S'ca,\ c�j k�r yi,; - ❑ Zoning District <br /> . .ZI This project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> S-IUT>Fr FEF.1_E 'PEP I.1ITHi lt.IFEF. ❑ Rural Address <br /> J FE.C.EF J FEFTI,_ (new/existing) <br /> HEL HT If FEET�J I11,'1.1E.EF F-T:_FE, '1 I t incl i iu J to,,-m-nt. <br /> 11 I ❑ 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 /> ❑ ErosionControl permit <br /> / � 4, TOTAL SQUARE FOOTAGE: 4, (stapes. disturbance. <br /> 1 filling/access) <br /> J iC FL C iP 1,,pr,FL_F-F <br /> y3 .a ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) -, 'o. '■ 'I. 'i 1 SOU and available options. <br /> � ov <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 -$No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? _ ❑Yes L]-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 i petition/appeal# i ileave blank if none i <br /> 6 Is a location survey required? i see reverser ❑Yes No ❑Don't know, <br /> 7. Is this to correct a violation? ,-..--E- Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i -► -+ <br />