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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER'S INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> 0/—`re'e'/ � -=/S`AJ'S z ❑ Zoning Status •
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed action;CSM
<br /> 2/ 77 V!,5.,.i.)..i fc-.'o . /A2A1 n, 5�---/ 6,1:2 S 3 70 y ance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 00 C. 17/ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> /i1 r"x ('‘"12=T?..ii L G✓ -i i.4.)✓.1,-,t, y-,0 r"). , ,� L ❑ Site Plan i ding location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS o septic
<br /> /vo/ /-, ".rc
<br /> (City,State,Zip ,/1-J (City,State,Zip) Setbacks
<br /> ( Avlti.t>•-ct) G 'X S:3i 7
<br /> PHONE PHONE ❑ Site Plan a al from
<br /> S-y 5-...S--/S^5 appli a township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> 4_?A,,,,<6,.'i, ,,,,.,.,,4<lt.yi,4r;H.,c.,,ELi,,, . Cc ❑yloor nstoscale
<br /> PROPERTY/LOCATION INFORMATION (http:llaccessdane.co.dane.wi.usn 2/Elevation PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: on oproperty
<br /> ❑ NARCEL �/ -/o -3 y y -5. L' R a / frontage drawn to scale.
<br /> NUMBER 0/ /U
<br /> TOWNSHIP: ,,J SECTION:
<br /> ySVQ K 3 / 1/4. .5i-- 1/4,�: 5)5 ❑ Drivew rmits
<br /> ADDRESS: ✓ l e,county,town)
<br /> z/ 7 7 v).;1A---c;),, cec') A ni5-o.� S' 3 ci -7 ❑ Sanitary s
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> (pu • ,private)
<br /> PROPOSED PROJECT INFORMATION ,./STAFF REVIEW
<br /> PROJECT DESCRIPTION:
<br /> Ae? (2,0. ,--1..<4_S ,F �, �h,�lr n / o.�L.1-) �Zphing •District
<br /> ❑This project is a new building or structure. D�Permitted Use?
<br /> G3 This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: CI Rural AddreSS'',
<br /> IrSEWER ❑SEPTIC (new/existing)...-'
<br /> HEIGHT IN FEET e 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) ErosionControl permit 2 c:„BASEMENT: 1ST FLOOR: ,,
<br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance,
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> .-- .G'
<br /> - fillinglaccess)
<br /> ❑ Review Location Survey
<br /> ESTIMATED CONSTRUCTION COST: ,?GCC �� and available options.
<br /> (Please round to nearest dollar) ♦ -4' ♦ ♦ "i $ > >
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 0 No LI Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 11610 ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes EiNo
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes C 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) CI Yes L J'N ❑Don't know
<br /> 7. Is this to correct a violation? CI Yes L7No
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08) r
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