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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> L I AI DA-c- .5/9Lt'/S RO ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street City,State,Zip) <br /> 35.7- L f1Kf SHORE DRI V6 f bag:DN I.Jt S Deed Restriction;CSM <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS / `� Variance(# ) <br /> -34 O ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 614c FN CIA M)N Fg— ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 359 c eP€R t-ft-INE._ . <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> 2'b& cV WI 5-353`f <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: LI Elevation of property <br /> ❑ PARCEL // frontage drawn to scale. <br /> NUMBER �jl� �e�sy ;1677" <br /> TOWNSHIP:n, SECTION:N Gv jii SV(`/s",�CZ�J5-jf fax... <br /> ih--B i Q 0 1/: 1/1/: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION - <br /> PROJECT DESCRIPTION: c� : <br /> sr� <br /> • ❑This project is a new building or structure. --L 'VAT// ' <br /> 4 gas -� <br /> p.This project is an addition/alteration to an existin. •• .' ructure. �' _ <br /> SANITARY SERVICE: r <br /> ., � <br /> EWER ❑SEPTIC ., a a�m�� z{ <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> " r' 34 <br /> AREA TO NEAREST SQUARE FOOT: ,,� <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) s. "` <br /> BASEMENT: 1ST FLOOR: �. x,, . " 1, ° 1 , 7 I <br /> ,, TOTAL SQUARE FOOTAGE: j . --1.<4,4€A <br /> 2ND FLOOR: 3RD FLOOR: :'of ® i <br /> ESTIMATED CONSTRUCTION COST: _- " iii <br /> (Please round to nearest dollar) ♦ -► "'� ♦ "♦ ♦ " ' 0'' "'°" <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? res ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 'es ❑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 L:lo ❑Don't know <br /> 7. Is this to correct a violation? 's *No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ -1. <br />