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'ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> I <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> rf i L A.. &NANbeSScr` <br /> ©'Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 2 t Sow 5+m s4-i.t-,4 M60r"-t-1.6,-0, t.» 53"S""4, Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 437 -29 y yS c1r\ICs eSSer'E Gr-kJ'.nt4- Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AG NAME CONTRACTOR NAME <br /> EN 3 a m P et■S 0 j e bocrrq n 140‘,.€(' pM4 ado„.‘ ❑`Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> In a3 8 A< <br /> (City,State,Zip) (City,State,Zip) g Setbacks <br /> nr bce , L.4.iI 539 13 �- <br /> PHONE PHONE © Site Plan approval from <br /> &CS—356-396c. applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> W- U.c• Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONINt. ACREAGE: �Elevatlon of property <br /> ❑ NUMBER t�5(. (e�.-( _s�')l_o RA---t Pi Z 7`3 i 31 frontage drawn to scale. <br /> TOWNSHIP: SECTION: 1 1 <br /> P '2 ,A. N E %%. NvJ Driveway permits <br /> ADDRESS: (state, county,town) <br /> 70)\ e` ` 1 It r 04 Sanitary permits <br /> CSM: LO SUBDIVISION BLOCK/LOT <br /> (public, •nvate) <br /> Sb6g <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ,T::fb-e_ 12- C/c1.1`` ie_ w- po ('c-- a- v n CO())1(\ U oning District <br /> 1 <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: Address <br /> ❑SEWER SEPTIC SIR R.$ new existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 3Z-( .-,4 Z Wetland/Floodplain/ <br /> oreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) EroSIOnCOntrol permit <br /> BASEMENT: 1ST FLOOR: <br /> t Sr-1'1 )1C o 6 y, TOTAL SQUARE FOOTAGE: ,` (slopes, disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/ac SS) <br /> 2t9C7 SZ, 4 AO. 9-as 9 ❑ Revi Location Survey <br /> ESTIMATED COfQSTRUCTION COST: ♦ ♦ ♦ ♦ /��O�G an available options. <br /> (Please round to nearest dollar) IO � <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes o ❑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 Li 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 blanlyif none) <br /> 6. Is a location survey required? (see reverse) Cl Yes @ No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ElNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545.112(4/08) <br />