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gNOUSc* <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Donald �.rr ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> WZo25 County Hwy I{ Columbus W► 5325 Variance <br /> ADDRESS <br /> SSite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME lit SIC CIrOSSb 1'xO1 1 elrcSSc �, ildevs lit LSite Plan including location <br /> AG ADDRESS CONTRACTOR DDRESS of well/septic <br /> pig Parodor Pi . 3411 m iI1c'- s+ <br /> (City,State,Zip) , (City,State,Zip) ❑ Setbacks <br /> PHONE ( rorr wi 53521 PYYI Qe I con i w i 53ici-1 pp <br /> ❑ Site Planapproval from <br /> �_5-�1-31095 W - 3115-640(0 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> r0 S53 A Ax1Co,CC>m ErFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Er Elevation of property <br /> ❑ PARCEL tvogp.!n-s220 T RR-- 2 c1.50 frontage drawn to scale. <br /> NUMBER TOWNSHIP: SECTION: ❑ Driveway permits <br /> Town 0-F V d r _5___ ' :__� — , $ -- (state,county,town) <br /> ADDRESS: <br /> Kraus Rd ❑ Sanitary permits <br /> CSM: I��� LOT SUBDIVISION BLOCK/LOT <br /> A N A (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> H DU sei O 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: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER ,SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES:: (Not including basement) <br /> I LP"Pt- ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: r-1 ErosionControl permit <br /> 1 4.53 14$ 3 4 TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> D9OID ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST --o• -0. ♦ —ii. I Q() o do and available options. <br /> (Please round to nearest dollar) i <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 ❑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 0 N ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes El No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />