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ZONING PERMIT APPLICATION www.countyofdane.colll sUP.PLEMENT_to:YYeb App#'. <br /> PROPERTY`DINNER INFORMATION:; CUSTOMER TO PROVIDE <br /> OWNE` . fO I '/ /77/97"—Z' ' <br /> D Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City s Deed Restriction; CSM <br /> 2--3 / , 42.A..-- Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS GSM <br /> Site Plan drawn to scale <br /> AGENT INFORMATION : j"- _ `CONTRACTORS-.1INFORmAilo_N,M.:',Wo ,=Lig and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> pT�Za,.a CJ�++^ 11C04111.) 0 Site Plan including location <br /> AGENT ADDRESS ONTRACTOR ADDRESS of well/septic <br /> '—P-a . rasp 7& 333 <br /> (City,State,Zip) (City,State,Zip) ' �(1--- D Setbacks • <br /> PHONE STb J J./_1_z __J W- -- <br /> PHONE ❑Site Plan approval from <br /> ©�©� applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS • <br /> El Floor plans to scale <br /> ;PROPERTY/LOCATION;INFORMATION I(httpe/laccessdane co da_ ne wti 41/ 3 " 'F" <br /> PARENT PARCEL NUMBER: q CURRENT ZONING:/�1 ACREAGE:_. <br /> j _ `� Li Elevation of property <br /> NUMBER 0611 231--/ ft .-�f (x�j frontage drawn to scale. <br /> TOWNSHIP: SECTION: J <br /> p 1,7 s ac�. - 5---,,,,,k n%f ... .:; ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> Z 3 2' T 0 Lo-e `/- <br /> El Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFFREVIEW <br /> PROJECT DESCRIPTION: rx� <br /> s <br /> �'�-�� � Zoning District , <br /> -T ii ti <br /> • This project is a new building or structure. P s k <br /> Permitted Use? , , `, <br /> ❑This project is an addition/alteration to an existing building or structure. _ �, .¢ fX - <br /> SANITARY SERVICE: PERMIT NUMBER: ® Rural AddreSS t <br /> EWER '— ew/ex <br /> - (nisting) - S <br /> HEIGHT IN FEET / ( r r NUMBER OF STORIES: (Not including basement) = <br /> l C LI Wetland/Floodplarn/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ® r= ` _rt.- a' <br /> BASEMENT 1ST FLOOR: �fOSIOnCOntf01 PErrTllt� <br /> f(?� +, TOTAL SQUARE FOOTAGE 4, slopes,(trat rb ge <br /> 2ND FLOOR: 3RD FLOOR: O 1 T flllto aCCegSSM2 <br /> x Review L�`ocation Stlfvey <br /> ESTIMATED CONSTRUCTION COST: j. ' ' �rdi'�7 <br /> (Please ♦ .♦ -0 --► -0 --► $ z Q -and available options* <br /> Please round to nearest dollar � Q� , '1� <br /> l <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes DNo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes DNo DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes DNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - DYes DNo <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) JYes DNo DDon't know <br /> 7. Is this to correct a violation? Dyes ['No <br /> APPLICATION MUST BE SIGNED <br /> s 11z aioe (Continue on Back) -► -► --0 <br /> ( ) <br /> • <br />