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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNERINFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME p <br /> -\6 �`AI� S,. �et_-C,*.3,11 5' 14v`A%q-V ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,Ci ,State,Zip) <br /> it ct C1 1Z. J, r CZcC y 5 Deed Restriction;CSM <br /> `" ` `� w, /, Variance(# ) <br /> HOME P_UON.g s� CELL PHONE E-MAIL ADD SS <br /> 0 -3 S 6 9y p 100 }I z-`t,fi? • U cla r e s Q'/ ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS / CONTRACTOR ADDRESS of well/septic <br /> (city,State,Zip) (City,State,Zip) LI Setbacks <br /> PHONE �� PHONE ' ❑ Site Plan approval from <br /> � applicable township. <br /> E-MAIL ARESS E- ILADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpJ/accessdane.co.dane.wi.us/) ❑ Elti <br /> PARENT PARCEL NUMBER: <br /> / CURRENT ZONING: ACREAGE: Elevation of property <br /> ❑ NUMBER 85(Q I o ✓a(O l 49 . 5a frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> , , LI Driveway permits <br /> LAd�) /�(of /a: /4: (state,county,town) <br /> ADDRESS: <br /> Ll CO ZOOS C. ki Z Ci ST ` ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION a d BLOCK/LOT <br /> S LI cc �EtiNrs A;y (public,private) <br /> PROPOSED PROJECT INFORMATION e� � <br /> STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> F( 114 3 PI KM 1tJ G CI A R A 6( )- I-�,b ❑ Zoning District <br /> . • lLl This project is a new building or structure. <br /> 0 Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: J Rural Address <br /> ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET: I J/ ii NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> . - Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> 'V I <br /> /A c "7D--_. ,, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: ,�J <br /> A X R 5.4a ❑ Review Location Survey <br /> ESTIMATED CON TRUCTIO)COST: ♦ ♦/ ♦ ♦ -► ♦ $ ��� and available options. <br /> (Please round to nearest dollar) <br /> The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes EtTio ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Flo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ENO, <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 3-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 ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes L3' <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />