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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 /> 'l111e✓ Coe/per-4f tie oning Status; CUP; <br /> OWNERADDR p(Number,Street,City,St Zip) //� /f'' ))� 1 = - '- • tion; CSM :17,,—,2--- <br /> �S <br /> 01 �uin i Ore b �/t 53S7 Variance L�r `�L <br /> (HOM,, PHONE CELL PHONE E-MAIL ADDRESS i ‘5E:- )i/ / G <br /> D L7)) " 3�' "J'Site Plan drawn to scale // /'0 1 <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimension / k� <br /> AGENT NAME CONTRACTOR NAME <br /> (114 n t a c -VI I e u a. -- ..•ing location l / A <br /> AGENT ADDRESS CONTRACTOR ADDRESS . .eptic l /�' <br /> �7�H �ndmr� _ / 1/�y <br /> (City,State,Zip) (City.State.Zip) Setbacks li /® / o <br /> S a Ctt.' (A),' S'313 3 <br /> PH•IE PHONE <br /> XSite Plan approval fro <br /> 60g 9 _• 0 • applicable township. � a © <br /> E-MAIL ADDR S E-MAIL ADDRESS <br /> 11 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn Elevation of property <br /> PARENT PARCEL NUMBER: CURRE TZONING: ACREA P P y <br /> ❑ PARCEL 0(3N 1 S-Lf 4 1d( )I / 1 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP SECTION: � �/J}- <br /> Malo/Ylani� V4 ,/,/. �Dr'_.:way permits 4. 4 4. <br /> ADDRESS tQ county,town) <br /> 1 O4I E+L � 141 c <br /> V//)/4 <br /> q� �/ � G-Y Cd; 5�C0 <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> JECT. SCR�°N Doff-- STAFF REVIEW <br /> e r jar f �Ou S� 2- ( V ,Zoning District C' 2 / <br /> This project is a new building or structure. 9 '3 Pi Permitted Use? IAA`� ` I Ls <br /> This project is an addition/alteration to an existing building or stru ture. V v_ff SANITARY SERVICE: f j�_++ PERMIT NUMBER: MRural�' .• - <br /> j SEWER 6 SEPTIC likk (ne ' '0 <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 3 CI 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 1 ST FLOOR' ErosionControl permit <br /> r_ �3 + TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> `O filling/access) <br /> 2ND FLOOR 3RD FLOOR: /+ <br /> 3 3( Review Location Survey ( A <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ GG// /ooU and available options. H— <br /> (Please round to nearest dollar) $ D_"T 0 /V <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes JNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ANo ❑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 No ❑Don't know <br /> 7. Is this to correct a violation? 4• CI Yes NO 4 6 ' APPLICATION MUST BE SIGNED <br /> soZ (Continue on Back) ♦ ♦ -♦ <br /> 545-112(4/OBj =- <br /> I/Q D <br /> 6, U v <br />