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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App <br /> °ROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> csAtIBS NINE 1 <br /> . ``pn VIA .Q..AY(r'o ie.a nkr ❑ Zoning Status;CUP; <br /> OWNER ADDRESS(Number.Steel,City'Stare'ZP) Deed Restriction;CSM <br /> L233 a, -i'orfa.r . �,e.�l'e5i-, Lso I ,S 3 J5a- variance(# ) <br /> HOME CELL HONE E-MAIL ADDRESS <br /> '20`g' ' Sago ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGRIT tave CONTRACTOR NAME <br /> eAie 0,A1Ct rhu' t D Site Plan including location <br /> AGENT ADDIXESS CONTRACTOR ADDRESS of well/septic <br /> (City,Stare,Zip) (City.Stare,Zip) .❑ Setbacks <br /> PHONE ❑ Site Plan approval from <br /> ren' 344' (p(Pq o2. applicable township. <br /> E-MAI ADDRESS E-MAIL ADDRESS <br /> 0.-1 (y('-tgaSt (36 i5C •e ci ❑ Floor plans to scale <br /> PROPERTY LOCATION INFORMATION (http: accessdane.co.dane.wi.us 1 <br /> PARBiT UMBER: + t rTZONMiG ACREAGE: El Elevation of property <br /> Pa NU 01�0%10.0. 1 •z3,21-`i <br /> 6" I U ,is frontage drawn to scale. <br /> TOWNSHIP: �{�.�`� , /y SEC/TIION. , Ji , , ❑ Driveway permits <br /> LA Itnon cr 3 .: t' �+ �4%. 1 J 0 <br /> ADDRESS: (state,county,town) <br /> CSM: LOT lII ) SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> 011+1�4 1"T (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PRO.EpT DESD R`IPTION: <br /> rig i1 '1cr, ok Toted (t` tk.. Li 1Y1S Off prern(6-iti. gi9C) ❑ Zoning District <br /> . El This project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not induding basement) ❑ WetlandiFkxx lain/ <br /> 1 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: ❑ Erosion Control permit <br /> X 3 +TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 5 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -, -•► -I. -t• ♦ and available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a(For lake?.±t ... Ef Yes ❑No ❑Don't know <br /> 2 Is there a wetland or floodplain on or near the property? ❑Yes IrNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 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) ❑Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes el No <br /> APPUCATION MUST BE SIGNED <br /> 545-112 cayael (Continue on Back) -1 -► -► <br />