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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNERaNAME <br /> f7/c k n ry t,c)0 o d //n i i L S L�c_ Zoning Status;CUP; <br /> OWNER ADDRESS (Nu ber,Street,City, te,Zip) ,/ Deed Restriction; CSM <br /> y8 p/ Fe a 17 /1G�' C clso o` al/ S3 71 g Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> a6_ -e/Li a3o? ! ,iv 4) q4��f .01 '" Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> G C , (SO vi McCo? 14.)4906,1 yo <br /> S Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> y/ V f?//G#70f gel V89/ P//aiid Rd <br /> (City,State,Zip) (Citty�fState,Zip) detbacks <br /> M41/10fr+/ GV/ 537/S , '(cell Sd n, G✓/ 3-37/, <br /> PHONE PHONE . site Plan approval from <br /> 076 o? -SW-0730f 2 6 al _4,yy-.7 349 applicable township. <br /> E-MAIL ADDRFESS E-MAIL ADDRESS dFl00r tans to scale <br /> Zcett I co>1 8 7 a• o./-Go�� /lc/lo ooc� Aormes / runt 1 p <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACRE GE: <br /> PARCEL , frontage drawn to scale. <br /> NUMBER 4r8 fob/l�I 3�7-yov3-� /�`� <br /> Tt SHIP: /– SECTION: <br /> J /a. N �aA: 3 y p <br /> w , � , , Driveway permits <br /> o`t'M o G'' reg(t i ' (st te,county,town) <br /> ADDRESS: /lave n e c <br /> Cre,e/c ei /C« ! ? 1/6 Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> (re „ VI h <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 2 G ti r lio i -v e- ❑ Zoning District <br /> his 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: CI Rural Address <br /> FIEWER ‹TIC /3—0020,7 0009/ (new/existing) <br /> HEIGHT IN FEET: t 1 NUMBER OF STORIES: (Not including basement) CI wetland/Floodplain/ <br /> 2 <br /> q / Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) I-1 ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> .2!2 P S i .e4- 3' , 1 O 9 31 . P-4- ,, TOTAL SQUARE FOOT GE: j (slopes, <br /> disturbance, <br /> 2ND FLOOR: 3RD FLOOR: a <br /> 4--- <br /> / 1/o ❑ Review Location Survey <br /> ESTIMATED ED CONSTRUCTION)COST -► ♦ ♦ ♦ $ p` and available options. <br /> (Please round to nearest dollar) $ / <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ar o QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (le a blank if none) <br /> 6. Is a location survey required? (see reverse) es o ['Don't know <br /> 7. Is this to correct a violation? QYes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -+ -► <br /> 545-112(4/08) <br />