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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME 1,e e'/� <br /> 1$ i4 1.100d 10 Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State Zip "� Deed Restriction; CSM <br /> 5 7 Po <br /> 9 '4'5e . /v/6//'SM, id) ') 5 7icP Variance(# ) <br /> HOME PHONE COI PHONE E-MAIL ADDRESS <br /> Site Plan drawn to scale � <br /> AGENT INFORMATION � CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME / <br /> .-rlt���,Pasc C v t54✓G1'/.,.- Site Plan including location &" <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> /1/.3.4)41 Ale{ <br /> (City,State,Zip) (City,State,Zip) rgl Setbacks 6 3/30//O/j 0 <br /> Co/17.445 ,Wi S 3125 <br /> PHONE PHONE gl Site Plan approval from „ /� <br /> J <br /> Q .770-- fbi, applicable township. /V <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> G.'S01 i1l00w .13.......6 0 7444,,r, 2 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBE URRENTZO NG: ACREAGE: <br /> El NUMBER Q�/0-- /l��—��� /1 — / S frontage drawn to scale. <br /> TOWNSHIP: SECT <br /> r 14: Nb- ,/,/: fil:: fa Driveway permi <br /> ADDRESS: (state,county own <br /> C, e. <br /> LOT SUBDIVISION BLOCK/LOT Sanitary ..,ts <br /> l5 9 (public, WI% <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECJ SCRIPTIgN: — <br /> ni7 di le J ni .e 4 / 4',�/2 l/0 it 3Z ' AZoning District <br /> ['This project is a new building or structure. g ermitt se? 1 <br /> [This project is an addition/alteration to an existing building or structure. a - ,� o t <br /> SANITARY SERVICE: PERMIT NUMBER: Rd <br /> ural ' •• •;..; <br /> EWER ] EPTIC (ne -xistin•) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) <br /> .2, ' . -;, _ . .4 ...plain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> ho - - • attachment) /�- <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1 ST FLOOR: r rosionControl permit �� i <br /> /D' 3 Z 1 TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> fiNing/at:cess) � <br /> 3 7v Review Location Survey f <br /> ESTIMATED CONSTRUCTION COST: ♦ —► -+ and available options. N/� <br /> (Please round to nearest dollar) 7 sd0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes r Vo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes EyVo QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes ao <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) Dies JNo ['Don't know <br /> 7. Is this to correct aviol- ' �;... [Yes QNo <br /> 2 . t,0 APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) ■ —. <br />