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' 'ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUS MER TO PROVID <br /> OWN R NAME <br /> / > <br /> C eAfP ?�ta/ (46/1// Ed <br /> �j� Zoning Status; CUP; e...) <br /> ERADDRESS (Number,Street City,State,Zip) Deed Restriction; CSM <br /> /71y S/y/del /c,/ . / / , G/ 31,172 Variance(# ) 6 ',‘ <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> /37-?.15 9 6/•7-'1 '1 lied 4,r i:/Z , I 0 a . ( ❑'Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ,t1t c.-G/v"e- I/Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS /of welVseptic <br /> (City,State,Zip) (City,State,Zip) L/ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 12/Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y <br /> ❑ PUMBER 0606-353 *Pi — -- /Y /G. ` frontage drawn to scale. <br /> TOWNSHIP: SECTION: ,�/ �� <br /> Sae. &2 "�&6 33-- '/4: 4/.Z---- WA: ,S'4,/ L7 Drivewaypermits <br /> ADDRESS: / / / �/ ,/(state,county,town) 2 0 <br /> //49/ Sr a/"1 ' ,j/ $' ' 4/2 ;Scf�S�'2 Ly Sanitary permits pQ <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, private) 2S)- <br /> o " <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT RIPTION: / - <br /> ��r/ y00 <br /> /L/iO/14/ (fit- Lao, D)6tfIC� �� <br /> . <br /> This project is a new building or structure. permuted Use? <br /> ge.rf---(7.. r <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER A/Rural f ` <br /> r '-� <br /> ❑SEWER SEPTIC D N �e ..,y ,< .i-,' )♦ <br /> HEIGHT IN FEET: <br /> I NUMBER OF ST IES: (Not including basement) •/ .. +ta s'•r,kT <br /> AREA TO NEAREST SQUARE FOOT: o � it ctiment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or po es) 0 Ems.onCcmtro1 Perms /e <br /> BASEMENT: 1ST FLOOR: / <br /> /O4 j TOTAL SQUARE FOOTAO- (slopes,disturbance, q <br /> 2ND FLOOR: 3RD FLOOR: tilling/access) C <br /> ,a,,,- ,0 •Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ -4► ♦ $ ;off a� available options. �� <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes f�No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [tYes ❑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) ❑Yes ❑No aDon't know <br /> 7. Is this to correct a violation? DYes 21No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► ■ —► <br /> 545-112(4/08) <br /> i2/6 <br />