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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OwNF�2 `E B <br /> OWNERADDR (Numbe rate, ❑ Zoning Status P; <br /> '��� > c)„ f 1 �u� ..,l' 1i'( S35( D d R ction; CSM <br /> 11.1 J(GUIp ONE I LADDR1 S al'. ce(# ) <br /> HOME PHONE CELL PHONE p MAILADDRESS <br /> ,01� N: ,Qoa9 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION a includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 1116_6:Za)v‘ klrez)1.,--.L.% Sties x,.,--51-___ Site.Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS Of ell/septic <br /> ,L(S (—bf:z-ovt Dr. ILL-( <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> ire rJ�- ) U.D. -Y- S35Li 3 <br /> P ONE PHONE ❑ Site Plan ap from <br /> cp()?) ?-1 B .. OC applic townsh. . <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ F or ns to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.c..dane.wLus/) <br /> Elevation of property <br /> PARENT PAR EL NUMBER: CURRENT ZONINe. h? 1•CREAGE: p p Y <br /> ❑ PARCEL tAu moo a69.0001.D RA. 3 Q 119 frontage drawn to scale. <br /> NUMBER V V w u V [� u ..J <br /> TOWNSHIP. SEC ION: <br /> (p j\ �kaa,.-. 5- o(Q %: Nw 14%: jqw ❑ Drivewa mits <br /> AD Ess: (st ,county,town) <br /> 6©n kit "` k-_1 "IS\.v._.w k M 6\ -..3--.- \ "mo t <br /> ❑ Sanitary per its <br /> CSM: (tes).$) LOT A SUBDIVISION BLOCK/LOT (pualic, • ate) <br /> PROPOSED PROJECT INFORMATION 'TAFF REVIEW <br /> PROJECT DESCRIPTION <br /> I X al V)QC.k.- ning District <br /> . ❑This project is a new building or structure. Sermitted Us ? <br /> ,This project is an addition/alteration to an existing building or structure. r <br /> SANITARY SERVICE PERMIT NUMBER: f'1 Rural <br /> ❑SEWER SEPTIC (new/ Istin _ <br /> HEIGHT IN FEET: 9 ( NUMBER OF STORIES: (Not including basement) <br /> 9 ❑ Wetlan otlplain/ <br /> Sh and (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:8°1_1 <br /> ErosionCont • •errnit <br /> 4, TOTAL SQUARE FOOTAGE: 4, (S1E3peS = rbance, <br /> Z.; cces ) <br /> SOLI fills. <br /> 2ND FLOOR: 3RD FLOOR: -P+ <br /> L. - ie • ation Survey <br /> ' ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ C-� o 0 an. - ailable options. <br /> (Please round to nearest dollar) / e <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? ❑Yes 14No ❑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 'l.No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 'No <br /> xr� APPLICA MUST BE SIGNED"d(545-112(4/08) <br /> ' (Continue on TION Back) ♦ ♦ —► <br />