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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> L i-A L)ai- T�cof [/]Zoning Status; CUP; <br /> OWNER ADDRESS <br /> (Number,Street,City,State,Zip) <br /> p Deed Restriction; CSM c4)124-Ni ST A f1 SO�l i ln)- 3-70 Variance <br /> (# ) <br /> HOME PHONE CELL PHONE E-MAIL AD ESS <br /> 608 ZOg•33.q8 1,i 7--i t ot)av av,'1- arolei; . ' Co"V► ©Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME LAnt tY�A PING <br /> A-44nrr C42beNIN iff Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> -3o cS' S IaCaE(-(-S 2 <br /> (City,State,Zip) (City,State,Zip) [Setbacks <br /> M t -FA-2t.•4A1 w s <br /> PHONE PHONE / VI Site Plan approval from <br /> (00'23 0 ?, '2_0 54 L- applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> [,Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dano.wLusl) <br /> PARENT PARCEL NUMBER: -5 CURRENT ZONING:!.0-r— ACREAGE: g Elevation of property <br /> ❑PARCEL r�,� /� �!' frontage drawn to scale. <br /> NUMBER bit(-3:3-'��- e _. �-- j Z5. Liu 44G g <br /> TOWNSHIP: SECTION: <br /> i'C WA1 OF CO'PFACet Ctvo.,./a✓ 3( 1/4: 1/1/a. 10,Driveway permits <br /> ADDRESS: (state,county,town) <br /> .e7O cc S I CtiCa Et-EV.D1k\ t2.p hc( C PA E t.AN D, / W 1 S3S S'� _ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: sr e.)..ifl --s-I6..-1 <br /> 1■STAu- N t:W Cot14 PANS''j Csi,kS 0•--1 P2Ert-i►S'E ❑ Zoning District <br /> . ❑This 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: ❑ Rural Address <br /> EWER [)EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> ❑ ErosionControl permit <br /> ,l TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -► ♦ ♦ -► -► -► �� oa and available options. <br /> (Please round to nearest dollar) d` <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? nYes Erio nDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies lv Jo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? RTe ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ()048 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ['Yes ❑N ❑Don't know <br /> 7. Is this to correct a violation? Des atAo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —0. —P —1 <br />