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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 /> DRu C'e. A d ze m f C ti LP 4 —� <br /> Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction;CSM <br /> 21E0 CT H L/ri />4Y ' .--) Variance(# ) <br /> HOME PHONE CELL PHONE ,/ G1%, E-MAIL ADDRESS • <br /> n A =5- '7 r Cgc-res ') <br /> 2 lue-teorn VrSite Plan drawn to scale '7 <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions fi <br /> AGENT NAME 1 CONTRACTOR NAME <br /> VOID N Iv) e► r-'is-H - ; Ociipoi✓I e, (^.not [Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> SO10 "Mxil N' t4 I` bA N4-113 ripe R1 S' �� ry <br /> (City,Sta ,Zip) n (City,State,Zip) , Setbacks 2 A ` <br /> A c i e ,)1:, e Iv) 33s2.7 I , I)if t LAmi et" , X11 53190 <br /> PHONE ( PHONE Site Plan approval from vii <br /> L-10g - 2)�- `r)‘-j i 1 applicable township. / — <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ),%CVe ' S f,(t, 9 6, C i)1 M Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: / P P rty <br /> D UMBER o$1/-3s4/-g /00 - U 4-2 -(2 ) 2 .6,95 frontage drawn to scale. <br /> TOWNSHIP: SECTION A <br /> &'i rhoiR/Lu 3 V '/a: /vl E 1//1/a: //6 0 Drivew- its <br /> ADDRESS: N C (stat cou I I, •wn) <br /> CSM: r LOT D D SUBDIVISION ��� BLOCK/LOT <br /> Sanitary •- Ills <br /> 134j g� Z n A n >4 (public, • - s <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> GRAIn Y>Ji s - m <br /> - sn-/l ,b/ay . Zoning District 4 ",a <br /> . OThis project is a new building or structure. iPermitted Use?S ', <br /> ❑This project is an addition/alteration to an existing building or structure. t <br /> SANITARY SERVICE: n PERMIT NUMBER: 'daRural A.•tz <br /> EWER [EPTIC / n/'7 (new -xisti ,!' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 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) <br /> BASEMENT 1ST FLOOR: L/C ErosionControl permit•.� > <br /> 4 TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, A / <br /> 2ND FLOOR: 3RD FLOOR: 3 f lling/access) ht�� <br /> ��" <br /> ♦ D q <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ _„ ..• _o. _+ $ 50 Qn U o and available options.(Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes ao DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes o DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? 21Yes to <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Eyes EVo <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) QYes Oslo DDon't know <br /> 7. Is this to correct a violation? Dyes ao <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ ♦ —► <br /> 545-112(4/08) <br />