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1 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> r31 l)c l C mi l 1/ J:' 1 :Ot <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME I <br /> DA.„� 4- /1,}`-2-`l / TLi C t'-f /'U ❑ Zoning District <br /> OWNER ADDRESS (N tuber,Street,City,State,Zip) <br /> uls gP.)L-5 .®Dr-b 'R 1.)C 535 L'Z ❑ Permitted Use? <br /> PHONE t E-MAIL ADDRESS <br /> ,'ISC) 4t ❑ Zoning Status; CUP; <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Restriction; CSM <br /> A ENT NAME CONTRACTOR NAME <br /> Variance(# )Pc�i 2.vC1�TE� �C- sl e- <br /> 3 a. COO S1- u_C_. <br /> AGENT ADDRESS CONTRACTOR ADDRESS ❑ Site Plan drawn to scale <br /> —Ac l5 9.-AOLss 2a.s.t> ?cola Q -S Roams and includes dimensions <br /> (C' ,State,Zip) (City,State,Zip) <br /> 515-z 1 t,,,'-lE ■'`d r- ❑ Site Plan including location <br /> PHONE PHONE of well/septic <br /> 13 SCLk103 IP 2t4 Io <br /> E-MAIL ADDRESS E-MAIL A DRESS • ❑ Setbacks <br /> ,� c Cuoeos. 1— toZ a) Cito,-0 -.,.. :r <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> ❑ Site Plan approval from <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: <br /> ❑ PARCEL C S 4 c C .)- <br /> dsCO{ (7 applicable township. 1 <br /> NUMBER - ��Pl 1 D <br /> TOWNSHIP: SECTION: ” <br /> n�\ \�Z� ` ' , ,/,/ r«=-'�❑ Rural Address <br /> ADDRESS: fJ 1/4: 4 4:�-r 4 t ,Crew/existing) <br /> .71p\j c''-Ai;`S A Dom'' z 53.Z 7 ❑ Floor plans to scale <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> ❑ Elevation of property <br /> PROPOSED PROJECT INFORMATION frontage drawn to scale. <br /> PROJECT DESCRIPTION: <br /> 1)E,A..) 4oi-kE --1-c) act1Ai 1.443.,4t, O._STIZO-W Gip Driveway permits <br /> . (4-This project is a new building or structure. Ft (state, county,town) <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> ❑ Sanitary permits <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> El SEWER -g SEPTIC S( q'c tai (public, private) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ❑ Wetland/FIOOdplaln/ <br /> t g 1 Shoreland (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 /> j TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> V46 uo0 filling/access) <br /> 2ND F OR: 3RD FLOOR: <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) Z �•c <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes lo ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes 93 No ❑Don't know <br /> 3. Have you talked with the township about your project? Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes NI No <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes tgNo ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes M No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(1/08) <br /> (Continue on Back) -* -s. -► <br />