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Z-47 tf. <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Kurl- 4 I-i UI tv (AiH r 'an oning Status; CUP; <br /> OWN ADDRESS/(Number,SPtreeeet,C.�,,F//State,Zip) ` Deed Restriction; CSM <br /> H�/ q� 1�1 1 CELL PHONE �GU�k C f , WI 5 5 8 3 V /lance(# )E-MAIL ADDRES <br /> &!_tr ?i r C Z�rr <br /> L+ - 1-] 20- � 1 , .� ) • Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <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/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> Li PARCEL I [J _ 1 2 0o+- — frontage drawn to scale. <br /> NUMBER 1 T <br /> TOWNSHIP OXh SEC=ION: <br /> 1L) IJ ,/4; ❑ Driveway permits <br /> NU-� <br /> ,�°,�4' �- „a (state,county,town) <br /> ADDRESS: �rfj 1 ?" ,� (4J, y'w.y` 7 r ! ,..�� <br /> �1 �n�le obE( u t ""' �? L1 Sanitary permits <br /> cSM: �� I oT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: 3 rIY 11„ <br /> ❑ 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 structure. <br /> SANITARY SERVICE: PERMIT NUMB R:�� /- ❑ Rural Address <br /> ❑SEWER SEPTIC /V�V!-, (new/existing) <br /> HEIGHT IN FEET: NUMBER OF ST RIES: (Not including basement) <br /> 12 ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO EAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> 3 20 2. <br /> 5 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 3 -7/” < t <br /> (,,,I •l�j ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -+ ♦ $ and available options. <br /> ♦ <br /> (Please round to nearest dollar) $ 3 a C..O, [? , <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 /> Is there a wetland or flood lain on or near the property? ❑Yes No ❑Don't know <br /> 2. floodplain <br /> 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? Li Yes Igt 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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ANo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► -p <br /> 545-112(4/08) <br />