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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER'INFORMATION <br /> `"` - - CUSTOMER TO PROVIDE <br /> OWNER NAME. <br /> David 0P' ie_ ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 536 Cj- i ' R� .V,51.9.1-,ton (a) .;'35-3y <br /> Variance(# ) <br /> • <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 60g yes"V4/V _ e, ckn-)•. f z © ; ma) I Co m ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CON -.CTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADD SS CONTRAC •-ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/laccessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: LI Elevation of property <br /> 0 PARCEL frontage drawn to scale. <br /> NUMBER 000(05/a -/0 /- 9f5'o-v /, 6 <br /> TOWNSHIP: SECTION: <br /> /6/.0 Y1 d Cg IA: M' SG`1/41/4: 5:r ❑ Driveway permits <br /> ADDRESS: /� n (state,county,town) <br /> 53‘ Crai? lid- �'dyt,-�',,>1 , CJ/ 5353 <br /> LI Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION/ <br /> 1 a, - o` . L000c9 c a ❑ Zoning District <br /> . a This project is a new buildi . or structure. <br /> Permitted Use? <br /> ❑This project is an addition/altera to an existing building or structure. - <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET: NU :ER OF STORIES: (Not including basement) <br /> r r ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE -SOT O Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages a ' a•.ve grade decks or porches) <br /> ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> 7/ + OTAL SQ OOTAGE: j (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> /d ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -). --0. ♦ -+ ♦ and available options. <br /> (Please round to nearest dollar) i -7 oo <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI 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? El 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) CI Yes LI No -Don't know <br /> 7. Is this to correct a violation? Li Yes to / <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —0. <br /> 545-112(4/08) <br />