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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT#o,web App:# <br /> CUSTOMER TO PROVIDE <br /> °VIER NAME <br /> ,A`L4 N /"t, ad- G• ,? /1'Octe- 4of- he (Zoning Status; CUP; <br /> OIVNER ADDRESS <br /> (Num r,Street,City,State,Zip) <br /> o Restriction;CSM 6Co ("p/- c,e,i4` J/ 'y 0 r-015( 2(ct S r Deed ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS • <br /> O 320 Site Plan drawn to scale <br /> _AGENT INFORMATION `CONTRACTOR INFORMATION`?', £ _.: and includes dimensions <br /> ' AGENT NAME CONTRACTOR NA E <br /> w <br /> - �-. u l f Qt. ['Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ALtRESS of well/septic <br /> lit f5 n-rc-te vale 4•l <br /> (City,State,Zip) (City,State,Zip) `Setbacks • <br /> PHONE PHONE CA (4/L-- 3soe �ite Plan approval from <br /> 601 ' 4g-to 114 ( applicable township. <br /> E-MAIL ADDRESS E- 4ILADDRESS nn • <br /> -eIo,,,.a� V /r 9H y l;ve ,co,,.FifFloor plans to scale <br /> :PROPERTY/LOCATION INB ORMATION ( ttp// esancoan __ " i: E de _d . . levaton of property <br /> ZONING: ACREAGE: <br /> ❑PARCEL frontage drawn to scale. <br /> • NUMBER <br /> TOWNSHIP: SECTION: <br /> C12c�S ?L O\ — %4: %'/4: ❑DtOti( <br /> (s nty,town) <br /> ADDRESS: �] <br /> i'lZ-- CL :\. it- -/ ' Zi)-- ❑Sapitjry mits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (pu lIC nVate) <br /> PROPOSED PROJECT INFORMATION _ '; <br /> STAFF:REVIEW <br /> PROJECT DESCRIPTION: ▪ Zoning District <br /> ❑This project is a new building or structure. l F e[ ' <br /> Permitted Use? , <br /> ['This project is an addition/alteration to an existing building or structure. .' ' ¢ <br /> SANITARY SERVICE: PERMIT NUMBER: Rural Address. :_ - <br /> EWER IEPTIC ` ew existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) r� *_,�., Qri <br /> { Wetland/Flood lain/ - <br /> P <br /> Shoreland(attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> t rf <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) = x r <br /> _▪� EroslonControl p'er'mit <br /> BASEMENT 1ST FLOOR rslopes CT r <br /> 4, TOTAL SQUARE FOOTAGE j 4. ; tsturban_ce <br /> sis fill)■∎-%access) A . <br /> 2ND FLOOR: 3RD FLOOR: ai• ._ v <br /> -f-ii k y'k T14g0..'93. x 7 - <br /> 9 Review,L}ocation.Survey <br /> ESTIMATED CONSTRUCTION COST '' '``�` "'3j ,frs` <br /> ♦ ♦ -i ♦ ♦ ♦ and available options <br /> (Please round to nearest dollar) ._ Fr? ? r t ,t <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? Dies ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Elves ❑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) Ekes ❑No ❑Don't know <br /> 7. Is this to correct a violation? Elves ❑No <br /> 2-)( APPLICATION MUST BE SIGNED <br /> (Continue on Back) -I► ■ -► <br />