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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NOAE ��" <br /> &,1 f /� t✓,'(J(e er1 G;cse 0 Zoning Status;CUP; <br /> OWNER A412- <br /> SS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> (0 to Eq5 ? Greg Co t,et Pr e,e d0 Ssc - -I J-3 c ' Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Cj ZO -610 Hs76, Ct r; le, ?U. i e s e a y4w» cosh fl Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CCTOR NAME <br /> U)G may(NAME;/ („ ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 722--C C.151ei Zn <br /> (City,State,Zip) (City.State,Zip) ❑Setbacks <br /> S A' Crly tea- -2.5D3 <br /> PHONE PHONE ❑Site Plan approval from <br /> 0,,075-363 -C (3 U applicable township. <br /> E-MAILADDRESS E-MAIL AD N RESS I <br /> J Rc LL na, ,c'v✓r1 ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 0 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT /� ACREAGE: <br /> 0 <br /> NUMBER t�907-3 q3-$b�-O l�—� 2 - 2 frontage drawn to scale. <br /> TOWNSHIP SECTI : <br /> R(�v /1) 1h:,5W ,1/11/4: ❑Driveway permits <br /> (state,county,town) <br /> s-O <br /> ADDRESS: L f �/7L 4 <br /> ❑Sanitary permits <br /> CSM: LOT 3 SUBDIVISION BLOCKILOT <br /> L/e 3 , & S (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ❑ Zoning District <br /> . &This project is a new building or structure. <br /> ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER PEPTIC 13-2o17-0W y Z (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Z?.3 ❑ 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 1ST FLOOR: ❑ ErosionControl permit <br /> G 4, TOTAL SQUARE FOOTAGE: +, (slopes,disturbance, <br /> f g Z 3 ( � S filling/access) <br /> 2ND FLOOR: 3RD FLOOR 5 7"3 t- ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ���!1 X1,'1 and available options. <br /> (Please round to nearest dollar) (o Wv <br /> r <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ®Yes [}lo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes Ri No Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®redo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes slo <br /> 5. is this project associated with a rezone/CUP/variance(petition/appeal# /d 9 S-7-)- (leave blank if none) <br /> 6. Is a location survey required? (see reverse) QYes IDNo Doon't know <br /> 7. Is this to correct a violation? Ayes balo <br /> G 2_0 ( , ~' � APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> 1/ (Continue on Back) —I. -P. -4. <br />