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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 /> JiAL(e I1SER Cbbkletq c (WAS t(J ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) /1, 1 ()Rae()N t W i � Deed Restriction;CSM <br /> 1 10 Cllr �'��5 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6are3c oYv_ a' ( )1to ►n(t!6LCSt( 4 f t(, di/2.'' ❑ 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/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL db(U--vii-850(-4. A- 1&-`" - .3rj frontage drawn to scale. <br /> NUMBER O 1 <br /> TOWNSHIP: SECTION: <br /> UN I OE (°I 1/4: {Jw 1/41/4: (h)Z ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 41(0 r toRk7SDN) ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ,•-Pr�c c Cue.-1A--r- ClkogE t4(-nk N€In{ 0 NL ❑ Zoning District <br /> This project is a new building or structure. <br /> ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: NA PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET / NUMBER OF STORIES: (Not including basement) <br /> (r2 ❑ 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 FLOG <br /> ❑ ErosionControl permit <br /> c?b t- �)6 r ,' TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> Stdfi Ott 1�S <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ U and available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes to ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? L3 Yes %No ❑Don't know <br /> 3. 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? ❑Yes VNo <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 No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) <br />