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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME J (Once Use ONLY <br /> SfiepiN.t.niQ Caw..., Ci.rrs7aPJtr BQ1Lta.s. <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ❑ Zoning District <br /> qco 9 Cocao,n 1,•e, a $1oe.e.k r...-tx) 1,, .• �' 3 s7s <br /> PHONE ' E-MAIL ADDRESS / ❑ Permitted Use? <br /> 6°S — 7G7- /y/c/ Se cocvan -Fds. e7" <br /> AGENT INFORMATION CONTRACTOR INFORMATION ❑ Deed Status;CLIP; <br /> AGENT NAME CONTRACTOR NAME C Deed cestncttQrl;CSM <br /> t' <br /> C o Variance(# <br /> 0L.70.K CO KS/ <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> 4/6/C C7 V. ❑ Site Plan drawn to scale <br /> (City,State,Zip) and includes dimensions <br /> (City,State,Zip) <br /> 3l L C <br /> PHONE PHONE f /4.7i 5-3 57-s- ❑ Site Plan including location <br /> Go e —74 7- if itr/46 of well/septic <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> SC 40 et(a..d-r �I uteri !.Co»ti ❑ Setbacks <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: ❑ Site Plan approval from <br /> ❑ PARCEL ' H R ^^ applicable township. <br /> NUMBER O70(o-0)1 - O' 7O—b ` ' �L. $D q <br /> TOWNSHIP: SECTION: <br /> ❑ Rural Address e�'w®"`T /: '/'/: <br /> (new/existing) <br /> CSM: LOT SUBDIVISION BLOCK/LOT Li Pioor plans to scale <br /> PROPOSED PROJECT INFORMATION U Elevation of property <br /> PROJECT DESCRIPTION: / / / frontage drawn to scale. <br /> ho S R, r e vA c c e ( ►1 I c. d C4 77;0„L ❑ Driveway permits <br /> - ❑This project is a new building or structure. (state,county,town) <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER ❑ Sanitary permits <br /> ❑SEWER 4 SEPTIC (public,private) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> a.. ❑ Wetiand/Ficrodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ EIOSIOnCOntrOlpermit <br /> V- iO o 4, 3CiZ 4 j TOTAL SQUARE FOOTAGE: +, (Slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) <br /> 1 _2eo3r . <br /> ESTIMATED CONSTRUCTION COST: © Review Location Survey <br /> (Please round to nearest dollar) '■ 'r '♦ '♦ ♦ S �� and available options. <br /> -# Z0c7 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Id Yes $ 'No ❑Don't know <br /> 2. There is 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? 4 Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? E Yes :A Jo e e z oft e <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? X7 Yes ❑No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes ®No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(1/05) (Continue on Back) ■ ■ -+ <br />