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ZONING PERMIT APPLICATION www.countyotdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> & C. 4 Lin V t Il(ncA ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Numder,Street,City,State.Zip) Deed Restriction;CSM <br /> 3(o18 g'/It. 6rbvr2 it,tADisa✓ti WI 531) Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 5_42_0(0 z.z' -4L'0(P ECG'c..L0.'^n in. •' iyt0r•, 5 _ •'1.J Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGE T■AME CONTRACTOR NAME <br /> /t hr;S emid— CaSSic s a t o,1 (�,L, ❑ Site Plan including location <br /> AGENT ADDRES /, eirci- CONTRACTOR ADDRESS of well/septic <br /> ll(a �c,/ it(' IN.' ;LOU Grc1._ <br /> (City,Stat Zip) / (City,State,Zip) ❑ Setbacks <br /> O� WI „:2,___...--,,,,-h_----.... <br /> '7� <br /> PHONE PHONE ' ( � ❑ Site Plan approval from <br /> i pO o10 - CL/q� (oog 2O(a D(4‘14. applicable township. <br /> E-MAII,ADDR SS E-MAIL ADDRESS <br /> ✓Vl I ' G �6kf k r, i�� _ A - , i- co ,,_. , - i.. ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE p P y <br /> ❑ PARCEL Clog °�/nSF frontage drawn to scale. <br /> NUMBER V I�O-Z 4-(p2I3-5 /�l �17- . s� /'1 g TOWNSHIP: SECTION: 2.1,T 1 J r ZE <br /> M Se Ya: 36 y4�/4; ❑ Driveway permits <br /> `t '��� (state,count town <br /> ADDRESS: ( y'town) <br /> pbc45o0C) Jar.. 1l/ddt Icr 1 ,WI S3S(o2_ ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> .23 p , lewo� i-ii l <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 1444 Ccsn iicocnon) ,S►'l, <br /> jp tdrpu . c.0 d(5716 ziOtnt2 L] Zoning District <br /> . &This project is a new building or structure. Q Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. r <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> 0 SEWER Iiit SEPTIC 51 8 0 V (new/existing) <br /> HEIGHT IN FEET: , NUMBER OF STORIES: (Not including basement) <br /> 33 Z Ca 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 /> D EroslonC?ntrol Permit <br /> BASEMENT: 1ST FLOOR: �' <br /> 452-LO 45 7(1. <br /> 4, TOTAL SQUARE FOOTAGE: 4, ( to s,distlNbance, <br /> 2ND FLOOR: 3RD FLOOR: fllllFtg/acc @SS) <br /> 75/ /2/// 5ry 1 1 Li Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ (� _ and available options. <br /> (Please round to nearest dollar) S 57(, 000 <br /> , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Li Yes 2No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes iiii No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? 21 Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes M 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 ' Jo ❑Don't know <br /> 7. Is this to correct a violation? Yes ®No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-1t2(4/08) <br />