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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 /> 3 C t- Par4 1 I S •LC -)e PP L?v e- =t Zoning Status;CUP; V <br /> OWNER ADDRESS (Number,Street.City,State,Zip) Deed Restriction;CSM <br /> ;11 t't��+� <br /> P 0. :.. ,'� LA k( 141015 W� 53 551 Varian .- <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ' 0"6"11"-)56 , 'I 0-1 - 1 561 I-e vR ke e P+w l, 6J41-- '16 Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION =_ . _ <br /> AGENT NAME CONTRACTOR NAME <br /> a ml - .`n Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS _• of ,�- . <br /> 7 <br /> (City.State,Zip) (City,State,Zip) Setbacks i <br /> PHONE PHONE 1: -Site- approval from /11. <br /> J,,o,I.I1J1.1'.'AIN" • <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> 41111 Uj,Floo • - - <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) r <br /> PARENT PARCEL NUMBER: CURRENT ZONING: 1U Elevation of property <br /> ❑ NUMBER 0(012 0 Z i W. C r. . : •r 1, <br /> TOWNSHIP: SECTION: A <br /> r I 4-I a✓),� IV e IA: Sr � IA: ,�, Driveway permits <br /> C <br /> ADDRESS: (state,county,town <br /> Z9Z RoJKny R) 'Sanitary .,-...-.,. <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, dr Z <br /> 1 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW _ <br /> PROJECT DESCRIPTION: <br /> 0 k't Zoning District '4■∎r!!' ,6 <br /> . (X This project is a new building or structure. A'41 Permitted Use? W.3 <br /> ❑This project is an addition/alteration to an existing building or structure. p I t f 1 J <br /> „-c) <br /> SANITARY SERVICE: PERMIT NUMBER: I'I'- q <br /> ❑SEWER SEPTIC 5) 0O% �_ Misting / <br /> HEIGHT IN FEET NUMBER OF STORIES: (Net including basement) <br /> I /t- Wetland/Floodplain/ / <br /> 4- <br /> horeland (attachm <br /> AREA TO NEAREST SQUARE FOOT: S <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) /,.A ErosionCOntrd it <br /> BASEMENT: 1ST FLOOR: 1 +�� <br /> 9 Q M 1 4 TOTAL SQUARE FOOTAGE: , (slopes,disturba Ce, Z <br /> 2ND FLOOR: 3RD FLOOR:l A filling/access) / �� <br /> �-1 \ ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ —O. and available options. <br /> (Please round to nearest dollar) /ono <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 /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 121No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 54 Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 0 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 a No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► <br /> 545-112(4/08) <br />