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ZONING PERMIT APPUCATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN NAME <br /> Z1 W f Arne Lbbene-A .y, <br /> OWNER ADDRESS (Number,Street City,State.Zip) [�Zoning Status; CUP; <br /> 3212- 4 • Deer-led- WI 0555 ) Deed Restriction;CSM <br /> 3212- <br /> HOME PHONE CELL PHONE ) J E-MAIL ADDRESS <br /> 1 Variance(# t�� } <br /> •I-511G-36 t 2 DWG ie ahoo.co IY t MI Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAM <br /> TrOn Max% ibikt I4L5 [ [Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> Of wetVseptic <br /> 44cri U I[Af [rtDp' � <br /> (City,state,Zap) <br /> Setbacks <br /> (City.State,Zp) <br /> PHONE Ct Grove, vii, 5362-/ <br /> PHONE al Site Plan approval from <br /> 611- -13ial applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 0;y- 1rbYlllrah- , , Imo, ,VI Floor plans to scale <br /> PROPERTY LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE [l Elevation of property <br /> 0 NUMBER ONZ'. T'-1 -O 'G„ 4. [ frontage drawn to scale. <br /> TOWN SHtP � - SECTION: <br /> %,IW,vi1.k.. % %s 44: M Driveway permits <br /> ADDRESS: (state,county,town) <br /> 1uake,c 1 A, e, <br /> I Sanita ry permits <br /> CSM: LOT SUBDMSION BLOCK/LOT <br /> 04-3 cl 2 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: eal_ <br /> ❑ Zoning District <br /> ErThis project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. ❑ Permitted Use? <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER [EPTIC - - - (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1 ❑ VVetlandlFloodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Std stand (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)1ST FLOOR: <br /> Q ❑ ErosionConhnl permit <br /> x (1 .. 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 114+ ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ n and available options. <br /> (Please round to nearest dam) $ -1 A to. d.0 <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 o :Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? t/'es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Ill es Oslo <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 61 o [3on't know <br /> 7. Is this to correct a violation? [Yes `t o <br /> APPUCATION MUST BE SIGNED <br /> 545-112(408) (Continue on Back) -a. -op. -► <br />