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• ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> 1 R SAME y ci L.)...` ' LL Q. ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number eet,City,State Zip) Deed Restriction; CSM <br /> aLs 4 .. E4 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (gen-gf9 -oaet -a8').-7°f-C 3 46,r5 exaa.,1i1 li a 4. .Co j_ U Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> �3`F CO „„ 1 <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE J V I WT $ 3 71? <br /> PHONE ❑ Site Plan approval from <br /> 4,6 4—I14 • o 3 ae applicable township. <br /> E-MAIL ADDRESS E•�- LADDRESS <br /> f�tars�,�� 1• 3 ` 6 6 ❑ 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 /> ❑ NUMBER 6 Sid -e S f- L.SS-6 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> A I,V i 6 W 1/4: 6 2, %1/4: s- ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> ,6 $ .4w (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: 1 <br /> A-v-1,v.- ❑ Zoning District <br /> This roe is a new uildin or ructure. . <br /> p ) g ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER Xi/SEPTIC 5'' 1 y(8-7 (new/existing) <br /> HEIGHT IN FEET: NUMBER F STORIES: (Not including basement) <br /> .1-1 ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: / / ❑ErOSIOnCOntrol permit <br /> T 1ST FLOOR: <br /> c2.7 3 b 0 T '01�1 4, TOTAL SQUARE FOOTAGE ,l (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: g <br /> ,i; — ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ 3 ?c 6 Q0. 0'a <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes tallo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes I No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Wes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes l'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? DYes Vit No <br /> / C qg 0 , D 75 <br /> APPLICATION MUST BE SIGNED <br /> e45-112(4i08) (20 (Continue on Back) -► -► -► <br /> S''? 511 i , ©0 <br />