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I , <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU TOMER TO PROVIDE <br /> OWNER NAME i �-j �� <br /> A' Z ing Status; CUP; <br /> OW RADDRESS (Number,Street,City,State,Zip) ed Restriction;CSM <br /> 505(0 -}lw Q �� G `a D2 ariance(# ) <br /> HOME PHONE Ct LL PHONE E-MAIL ADDRESS <br /> ill'■ '516 -bTh33- 4). '''' • -6137 - -,, .cA,@ iS• �PIan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Isyi¢ C •'rH Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> Silt-c.) <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ['Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURREN ONING: ACREAGE: ❑ Elevation of property <br /> ElPARCEL b' , -' 2 _.t ST6 J , 'E� S f + frontage drawn to scale. <br /> NUMBER O \V <br /> TOWNSHIP: SECTION: <br /> ' 4 444 1/4:Nil '/a'/4:` y ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> Ala f-Q ULM& 5$ ' w+ 35-2.e ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> -AO.n,� / 6( I\Y LQ v ❑ Zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or stru tur . <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER N€PTIC / (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ,Y ( , ❑ Wetland/Floodplain/ <br /> F AREA TO NEAREST SQUARE FOOT: ShOreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErOS1onCOntrol permit <br /> BASEMENT: 1ST FLOOR: <br /> 00 f 3( 1 . TOTAL SQUARE FOOTAGE: j, (slopes,disturbance, <br /> 2ND FLOOR: v 3RD FLOOR: ^ j fllhng/aCC @SS) <br /> t \(F/'� ti ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> -0.. ♦ ♦ ♦ $ <br /> (Please round to nearest dollar) ` 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Elves ao ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑YesIo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Ekes ❑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 2:1No ❑Don't know <br /> 7. Is this to correct a violation? Elves 'lo <br /> APPLICATION MUST BE SIGNED <br /> 545112(4/08) 471/, 8C) (Continue on Back) ■ ■ -► <br />