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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 /> Eric. Sc+)beset ❑ Zoning Status; C <br /> OWNER ADDRESS (Number, t,City,State,Zip) <br /> Str <br /> ztb South �" S+� Deed Rest( on; CSM <br /> Varia (# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 4 ' + In 2ifigi 6on$` 2)er-/2S(, Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan in ing location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/ tic <br /> (City,State,Zip) (City,State,Zip) 2r Setbacks <br /> PHONE PHONE Er-Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> IB'Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Er Elevation of property <br /> ❑ NUMBER D`-/a/-g5b/ A-Z ,- frontage drawn to s ale. <br /> TOWNSHIP: SECTION: <br /> lbw116 RiY) lob '/a: 134 '/%: 1J ❑ Driveway rmits <br /> ADDRESS: J KE_ itef- k � (stat ounty,town) <br /> © C ❑ Sanitary rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (p private) <br /> PROPOSED PROJECT INFORMATION AFF REVIEW <br /> PROJECT DESCRIPTION: <br /> tin 3'l XI"14' <br /> IMF <br /> ping District <br /> This project is a new building or structure. Permitted Use? <br /> ❑This project is an addition Iteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ RUraI F @SS � - <br /> ❑SEWER SEPTIC /existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> fit=- as ❑ Wetl nd/F000dplain/ <br /> AREA TO NEAREST SQUARE FOOT <br /> S relafid( attachment) <br /> (Outside dimensions including unfinished area attar 9d gages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: �1/`�t�)(`rt) ErosionCOntro permit <br /> 39 A " y O j TOTAL,Ira FQOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: ?10 3RD FLOOR: <br /> /� o J (C.) filling/access) <br /> `�`-`1 ❑ Revi nation Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ -► �^ �� a vailable options. <br /> (Please round to nearest dollar) $ 3oJ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? -.Yes ❑ o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Li Yes N <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank • one) <br /> • 6. Is a location survey required? (see reverse) ❑Yes o ❑Don't know <br /> 7. Is this to correct a violation? CI Yes No <br /> I t APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ —► <br />