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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Aaron ' Cob Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City:State.Zip) j_'�' S Deed Restriction; CSM <br /> HOME PHONE 54'e s CELL PHONE 3Du�� E-MAIL ADDRESS <br /> RES5 354 Variance(# ) <br /> ■ $'. 3356 41'Site Plan drawn to sot-6 <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> tiletStut C.on r,iuA;c ' 1d`Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> Vq/5 i4rotii 51. mcia�r 1 w1 <br /> (City,State.Zip) (City.State.Zip) Setbacks <br /> 3 "`` • <br /> PHONE PHONE (,Jl Site Plan approval from <br /> 6cq-�G38'-.831$ plicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS �� <br /> ADi/lino. • 14 45 ws 4 Fldo't arls to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usf) 10 I( <br /> Elevation of property <br /> j PARCEL PARENT PARC NUMBER: CURRENT ZONING' ACREAGE frontage drawn to scale. <br /> NUMBER Pil6 OW -Olt -0673-2 4" l •757 <br /> TOWNSHIP: SECTION: , , Driveway permits <br /> �lPlt5A�1� � pq /4: �� /a/a: �� te,county,town) <br /> ADDRESS: <br /> 2$1C Si*re5k C . LI ,g_rsy permi ts <br /> CSM LOT SUBDIVISION BLOCK/LOT c,private) <br /> /3 AsAi )"r °ANr r <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJEC DESCRIPTION: <br /> 'ha swewell 4 so sede o Viouse, Li Zoning District <br /> . Li This project is a new building or structure. LI Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE PERMIT NUMBER. LI Rural Address <br /> (new/existing) <br /> J SEWER SEPTIC <br /> HEIGHT IN FEET NUMBER OF STORIES (Not including basement) <br /> ^r A. 0 E L__c...) J C, >z A c>c _ Li 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) L} ErosionControl permit <br /> BASEMENT I 1ST FLOOR: <br /> 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR 3RD FLOOR: <br /> U Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ ch OD� and available options. <br /> (Please round to nearest dollar) 'P ,r " <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes I4No LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? LI Yes $No LI Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? BYes j No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? LI Yes L]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) LI Yes )too LI Don't know <br /> 7. Is this to correct a violation? LI Yes IrNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4 ■ -i <br /> 545-112(4/08) <br />