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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App 0 <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWNER NAME <br /> I)4,1'C/9-1//. 1-1-A ,mss time/z,,�` -C; <br /> ❑ Zoning District <br /> OWNER ADDRESS (Number,Street,City,State,Zip <br /> 3E318 sJ 4L1 /1uhI OI S Off' tot s"--37/8 <br /> ❑ Permitted Use? <br /> PHONE E-MAIL ADDRESS <br /> COB _ 2 22_-/730 <br /> ❑ Zoning Status;CUP; <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Restriction;CSM <br /> AGENT NAME CONTRACTOR NAME <br /> ni/pil e.. F� // /-1.-ek.m5f/ /Z)-6‘.. Variance(# ) <br /> AGENT ADDRESS / )4.0t,Sa4 CONTRACTOR ADDRESS /1'1 I k'$ C <br /> 3e/ A. 7 4 1.e,'"- ��, 3g/8 c C� 4 1 �t //e ❑ Site includes drawn to scale <br /> and includes dimensions <br /> (City,State,Zip) S,7 �/ (City,State,Zip) <br /> /14 1919/S&L, Lc.)( C3 <br /> PHONE ((11 PHONE ❑ Site Plan including location <br /> 6.20 U .Z Z2—/ 7 3 U of well/septic <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> -4421.0e/trecLt Ae5• AJe7-- ❑ Setbacks <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Site Plan approval from <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: <br /> ❑ PARCEL 07/I1938/066 C_' / 2.447 a pp Itrable township. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> corr44,, 6t2vu-e 1 S' ) 1 1 ❑ Rural Address <br /> Iq /o: /n/n: /�1 (new/existing) <br /> ADDRESS: <br /> CSM: / LOT SUBDIVISION BLOCK/LOT ❑ Floor plans to scale <br /> 0898 ❑ Elevation of property <br /> PROPOSED PROJECT INFORMATION frontage drawn to scale. <br /> PROJECT DESCRIPTION: A, 1 <br /> AEC( /UM/ &1CC'(�/Dti ❑ Driveway permits <br /> . ❑This project is a new building or structure. (state,county,town) <br /> P(This project is an addition/alteration to an existing building or structure. <br /> ❑ Sanitary permits <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> F..]SEWER SEPTIC (public,private) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ❑ 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) I-1 ErosionControl permit <br /> BASEMENT: 1ST FLOOR: disturbance, <br /> ,1 TOTAL SQUARE FOOTAGE: + (slopes, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: /�� <br /> C}J�_ ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: 'r' ,l o� and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ "� ♦ r�V• <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes NEI No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes X4 No ❑Don't know <br /> 3. Have you talked with the township about your project? Wes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ZYes ❑No <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes lirNo ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes ,14 No <br /> -,,,,,(90 APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► -► <br /> 545-112(1108) <br />