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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 /> VAvE 4-AP- ENE WEIN61rD40- 14 Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 311-2- [-Iv ok6u- RO i IVIA'OISoN, WI 53�D 4' Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (/oi - 0$--A —ZIo5-2'' ►C` Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> I EOwN .- IA Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) A Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> IA Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL / �( 9/ r1 frontage drawn to scale. <br /> NUMBER O1�q-tfiv-iD!-000-v - , <br /> TOWNSHIP: SECTION: <br /> WO i-lob __Lt2 1/: 5t 1/1/: 5 W ❑ Driveway permits <br /> ADDRESS: (state, county,town) <br /> f3/2/ f/DEp/c.22 In19 V/5O/l/, IA/1 S37b,--- <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> 0a79-4-- (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> IWO 6907/11 20,0M AV/ V ❑ Zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> YI This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER pi SEPTIC (new/existing) <br /> HEIGHT IN FEET: ( NUMBER OF STORIES: (Not including basement) <br /> 5 I ❑ 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 FLOOR: ❑ ErosionControl permit <br /> 2 <br /> W 32 30 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: r� 3RD FLOOR: J J filling/access) <br /> 470 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) rod 000 t 00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes V No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes IANo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? lYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 1 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 t,pl No ❑Don't know <br /> 7. Is this to correct a violation? Li Yes caiNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 515_119 rd/rw. <br />