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1 S <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> A tiN d re W Crowe r. EIZO-n'ing Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 66 11 f Deed Restriction;CSM <br /> �OM PHONE Seam.•+HONE Road E-MAIL ' ) fie! W I 53506 Variance(# ) <br /> Gob-"170 - Li gso M..c)r Crave►• ale - 001).c04 0 rte Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> QiSi‘Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) etback <br /> PHONE .. PHONE e Plan oval from <br /> • <br /> applic a township. SQV� <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: VatlOn Of property <br /> ❑PARCEL Oyb/x507-331-t000-o AZ 31, B frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Pr I r■• r o5-% 1J e .1/4: 1/1/: ❑Drivewa its <br /> ADD ESS: !1 ( u ty,town) <br /> CSM: - LOT SUBDIVISION BLOCK/LOT anitary permits <br /> M (public,private) <br /> �r) <br /> lePROPOSED PROJECT INFORMATION AFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Kes -SILO .SI^.z Ck in District <br /> . IE This project is a new building or structure. P itted'Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT pUM %9 Rural Ad <br /> EWER EPTIC h7 <br /> (new/ 'sting) j' <br /> HEIGHT IN FEET: NUMBE OF STORIES: (Not including basement) <br /> l/, WetlanZ,9 PI,.•plain/ <br /> AREA TO NEAREST SQUARE FOOT: $h0 - -: • (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: Erosion OI permtt <br /> /� 4, TOTAL SQUARE FOOTAGE: j (slope d` turbance, <br /> lJ fllii _• access) <br /> 2ND FLOOR: 3RD FLOOR: / �y <br /> jv� J1 Review lion Survey <br /> ESTIMATED CONSTRUCTION COST: Q ; 1 v and a tl le options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ 1/ J� \...A/r----) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes jNo ❑Don't knoV <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 0 N <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) Ekes No ❑Don't know <br /> cie 7. Is this to correct a violation? ❑Yes INo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ —► —► <br /> 545-112(4/08) <br />