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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> I$WNER NAME yam,,�� <br /> ewes aria ! l Zct!" 61Ati WDr-� Zoning Status;CUP; <br /> OWRESS�,èrCcviLk Number,Street,City,State,Zip) Deed Restriction; CSM <br /> /156 Rd. Cot'i Grove , VJJI 5362-7 Variance(# ) <br /> .on -HONE CELL PHONE E-MAIL DRESS <br /> 468 S'31.440('& 222 t Mete, 4. , viovii, k, ' icon" P Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> (41+'Y or & 4 Ma..'k f3.4d1414in AMar1cv-0 44•14 p Roy:1 Itc, X Site Plan including location <br /> A ENT ADDRESS . CONTRACTOR ADDRESS nn of well/septic <br /> 0 PIG'GC+i,lle Pj, • T7jo 1;,,nor- 1)r. C. <br /> (City,State,Zip) (City,State, \Setbacks <br /> Code. grveiiJI ,5'3527_ S ►-�„ `e W1 5 5Yo <br /> HONE PHONE Site Plan approval from <br /> gs't (03$'3 '/99-8773 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> II , oW.YffiQ .i)U 'O4 • .Qr- % • -w .r a0 •Cvrrl Floor plans toscale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: property <br /> ❑ PARCEL •58/081• `l 8�o00•al R"l /, pS frontage drawn to scale. <br /> NUMBER / <br /> TOWNSHIP: ^ SECTION: 1 <br /> T wn Sam H'-a,irt-e __ .341 1/<: 6� '/4'/<: ,& {,(/ jisDriveway permits <br /> ADDRESS: • �j� n (state,county,town) <br /> ,56 ?terctvil(c Rd• C°f�e t51 rave' WI 535Z'7 )Sanitary •-rmits <br /> CSM: LOT SUBDI SI BLOCK/LOT (publ'�,private) <br /> 80`x.3 L. /yi A/ r4 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ���{ <br /> 'e, ukte1t-' eWAIU Zoning District <br /> . XiThis 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 NUMBER: ural ss <br /> ❑SEWER SEPTIC -- ne exlstin <br /> HEIGHT IN FEET: , I N NUMBER OF STORIES: (Not including basement) <br /> I.f 4 1 Wetland/F plain/ <br /> AREA TO NEAREST SQUARE FOOT: Sh0 d (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> ErosionC• rol permit <br /> Aip4 j TOTAL SQUARE FOOTAGE: + (slope •isturbance, <br /> ���� <br /> Min!,access) <br /> 2ND FLOOR 3RD FLOOR: t!D 60...g2______ <br /> 09-- eview Location Surve <br /> ESTIMATED CONSTRUCTION COST: -+ ♦ ♦ ♦ ♦ ♦ i ©0`�_ 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 QI,No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ®No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes 4No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ®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) EYes ❑No Li Don't know <br /> 7. Is this to correct a violation? ❑Yes 14,No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />