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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER'INFORMATION '°'- CUSTOMER TO PROVIDE <br /> OWNER NAME `�_ �l <br /> tAt' 5 L i, h 4 ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 1 Deed Restriction; CSM <br /> 245 3 Co ckti e -A t a i 1 R h6ufqy i J i._ 5 37 11 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (O Z-MLi ,G7$- -3`t - 5-S3 ' Ar ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> SC C34- .S4 ,\ ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ck S S C-CICIM -I tl . <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> R \c.1^be ,:.} L- - S 31 tI <br /> PHONE PHONE D7 Site Plan approval from <br /> 608"- 3 17- 3.5-55- applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> N 4 ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http a//accessdane.co.dane.wi.usl) . <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER C` 10"ZS.3 -4'a u' `( <br /> TOWNSHIP: SECTION: 1/4: ' 1 ❑ Driveway permits <br /> SW N /+/<: (state, county,town) <br /> ADDRESS:. <br /> 3S701.337 L u.ct_oe DrtU She ►. +� w 535 eq ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> It/l9 A9CV ❑ Zoning District <br /> 4 <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> his project is an addition alteratio o an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: LI Rural Address il <br /> ,SEWER ❑SEPTIC (new/existing) _ <br /> HEIGHT IN FEET: 0 NUMBER OF STORIES: (Not including basement) <br /> tG 3 i iory ❑ 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 /> ❑ ErosionControl permit <br /> BASEMENT 1ST FLOOR: <br /> ti R A A 4, TOTAL SQUARE FOOTAGE: ,j. (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: e <br /> A N A Ica .cit ` ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: d' and available options. <br /> (Please round to nearest dollar) ♦ --► . ♦ ♦ ♦ $ x100 (C!6 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? CI Yes N,No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 4 No ❑Don't know <br /> NA 3. Have you talked with the township about your project and are they in agreement? ❑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 5 N° <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />