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. � � � I/ <br /> SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLIC ION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> DaR�E.I■► -- f AI kt�(A U t)..).<Lea. j5c Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> . i 1.0• LS•{ DbC-RFiELD� ui . s35 7 Variance # <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS Variance(# <br /> 4C% - 235--9(b`t ? k e..14 1LLvt I.;K L'IRRt. _ c A Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> S4-t•tVA.tlT (CiL.AI.v(;- -t 64: . Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 316 ti ATu- Ct ) La ) <br /> V <br /> (City,State,Zip) (City,State,Zip) 'Setbacks <br /> ni.tw1r14-�n ) W;1-. 5.3S3 <br /> PHONE PHONE a Site P n approval from <br /> tick-- 2(S-72-7G app cable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Sc..14 vv.% cr ,L.�)CS c yi ti-cz= cc ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:I/accessdane.co.aane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ONING: ACREAGE: ❑ Elevation of property <br /> Li PARCEL I fronta e dra • scale. <br /> NUMBER oel -- -(,- 5ors-a R -� 2 <br /> TOWNSHIP: <br /> SECTION: rt-•"`1) Z.12t <br /> G 4t�I t A1.i PI ` E '/4: (J J 1/41/: Z ❑ Driveway per '. <br /> 70 <br /> (state,count ,town <br /> ADDRESS: <br /> - itary permits <br /> CSM: LOT •BDIYUSION BLOCK/LOT ,, <br /> •Ubll `" he <br /> t 2 l C`I � - �"' �/ <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> ;4PROJ,CT DESCRIPTION: a —` <br /> — F 1' _lS J - pl 9 oning <br /> District <br /> . NI This project is a new building or structure. itted. se? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: ERMIT NUMBER`", ❑ Rural Addres <br /> LI SEWER &SEPTIC 5 . I 1 1 Xlsting) <br /> HEIGHT IN FE NUMBER OF STORIES: (Not including basement) <br /> I i AWetda loodplain/ <br /> Sh and (attachment) ,. <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 7- <br /> BASEMENT: 1ST FLOOR: ErOSIOnCOntfol permit .--.0"\-7- <br /> I�Q ,(t + TOTAL SQUARE FOOTAGE: ,j, (slopes disturbance, �3 <br /> V ✓ <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: l . w <br /> 4' Review L tion Survey <br /> ESTIMATED CONSTRUCTION COST: $ q;,,, d av able options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ $ <br /> ►fig k <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? LI Yes J No ❑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 ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4108) <br />