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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 /> —MY -4--YY1IINbY SCH W EA)A-) ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 7 91 S [3/-464 IZ 1 V"t 1?1) Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> g29 - 1 cl g l T SC t vv eNiti 'c:1-te(2;r6 -6 i•JET- LEI Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Eat � <br /> � LA .3,e_., Qv', . T, •diff.1 ., , 1LC 21 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 106 P. Z-E40r1= be.. 'o6 IV,fitegY K Dry. <br /> (City,State,Zip) (City,State,Zip) Q Setbacks <br /> 'IN AU N Ptk.EE 1.k.):.E 53597 l/v PruN ft1L*E w-L. S3S`1-7 <br /> PHONE PHONE ❑ Site Plan approval from <br /> 60S- 2- s -l/51f 7 60g- 2-f - q S- Z, applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> QUN—CC 3 C'. c,k per, . NET Qu L N e cHMT61,,E- a/Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: C RENTZONI�/ / ACREAG§: Elevation of property <br /> ❑ NUMBER �$ O7O8 112 5022_j ( ∎ frontage drawn to scale. <br /> TOWNSHIP: S C `o� N ,S ❑ Driveway permits <br /> b l 1 DOLETON f '/<: '/<'/4' state,county, own <br /> ADDRESS: �/( ty town) <br /> 79 1S l3LACiL 1�t VC-& (�� l Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> ?-AIQtk- utSTA 2.. <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: L i 1 L.," <br /> 1.36(A) P�D1Ti0K) 3 1 X 27 Ma 6z gl)(2_ry-t ❑ Zoning District <br /> ❑This project is a new building or structure. <br /> ❑ Permitted Use? <br /> liti This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Li Rural Address <br /> ❑SEWER YLSEPTIC S I �S() ST) (new/existing) <br /> HEIGHT IN FEET: i NUMBER OF STORIES: (Not induding basement) <br /> I& 1 ❑ 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: , 1 ST FLOOR: ❑ ErosionControl permit <br /> 3 x G 2�f �/ Z-1 , TOTAL SQUARE FOOTAGE: ,' <br /> / (slopes,disturbance, <br /> / 7 filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> c 0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: - d available O tions. <br /> (Please round to nearest dollar) -+ -ii. -a. -I. -10. --P. $ ( S 33 OTD 6 p <br /> FZelsev:Oo O■.‘ d <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes EgNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes igi No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Wes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes iil.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 Iallo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 0.No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -. -► -+ <br />