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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT toWeb App <br /> PROPERTY O WNER-INFORMATION •, r-, '` CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> rsettiis k .$T 0 Zoning Status; CUP; , =-/ <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 30 IL MANI- -San Dr geed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 57 01l ' mV eta a C-4 w ecr, krSite Plan drawn to scale ■ <br /> 'AGENT INFORMATION.,, r.CONTRACTOR INFORMATION ° ; E ,`,-.,. and includes dimensions , <br /> ' AGENT NAME LAO CONTRACTOR NAME ,/� <br /> �Qe}N, A5 � grkki0 4 (�ut 5 .Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> ,, L/ /�{ of well/septic <br /> (City,State,Zip) /5'5 /"(v er . <br /> ,, (City,State,Zip) Setbacks 3 5/2_5 70 , <br /> OiuM6(t, WI 5392,5 <br /> PHONE .9 PHONE , ite Plan approval from <br /> ‘0$`85--z_ —‘864 applicable township. <br /> E-MAIL ADDRESS E-MAILADDRES • L <br /> r e` A o, ly Floor plans to scale <br /> ;PROPERTY/LO_CATION INFORMAT_ION (littpa/accessdane co_ da_ ne w.us/) _ ;A a: , <br /> PARENT PARCEL NUMBER: CURRENT ZO ING: ACREAGE: Elevation of property <br /> ❑N MBER 0)2/6 11I-1g1-2ps,�(1 A i 0 cj Z� frontage drawn to sca . <br /> TOWNSHIP: I SECTIOgN: , / <br /> ef,44-o 1 l / /: ,V iE W%: N& Driveway per <br /> ADDRESS: ^/ (state,coup town <br /> 30 l6 Md+�1��r'i- Sf/� Cr. gSanita .-.m <br /> CSM: LOT (/� SUB+IVISION ••/"f •T (publi <br /> Z O(1, �, . f. S7 " �es <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJEC E 10r,Ne 4 O�Gt s. �k " � <br /> t^ jZonmg Dlstnct r <br /> ❑This project is a new building or structure. �Permltteti Use70 �, O <br /> This project is an addition/alteration to an existing building or structure. - ,,, its l� <br /> SANITARY SERVICE: PERMIT NUMBER: RuralI;r;; <br /> EWER 4EPTIC (ne ex(sting) .: <br /> HEIGHT IN FEET: / / NUMBER OF STORIES: (Not including basement) r <br /> / 41 Wetland/Flootiplaln/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shoreland`'(attachment) ?' <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) = ~�f <br /> Erosli.Mtbl rol pECmlt <br /> BASEMENT: 1ST FLOOR: � � � ��.,v ▪ "'• <br /> 7--c 7- 4, TOTAL SQUARE FOOTAGE: ,i t slopes disturbance <br /> 2ND FLOOR: 3RD FLOOR: <br /> s filhng"�ac'''' <br /> ReviewLLocation Survey <br /> ESTIMATED CONSTRUCTION COST: ' and avalla""big options -- X_ <br /> (Please round to nearest dollar) ♦ '♦ 'i "♦ 3o 00�' <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? ❑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 Digo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► --11. -+ <br />