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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME 1 <br /> / <br /> (0c or.. a. Ai Lt-. [QZoriing Status; CUP; <br /> OWNER AD ESS Number,Street,City,State,Zip) <br /> D• ed Restriction; CSM <br /> 9o2. S41( Of` Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADD'ESS <br /> `7'10— e <br /> (��.l`1D —33�J ��' 3�3J Goo � ��) ' �'►7 � , Lvrr.. [�]�,fte Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION '�V"' nd includes dimensions <br /> AGENT NAME CON�T CTOR NAME Corp c. 4 A? f3)(5 rp Site Plan including location <br /> AGENT ADDRESS CONTRACTOR Of well/septic <br /> ?o tic 01 St,. <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> tsrotia / W1 ,' S1 / . <br /> PHONE PHONE ❑ pp <br /> Site/Plan aroval from <br /> 6 04- r 7 3- >'sJ ap iicable'fownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS '` <br /> [gloor plans to scale <br /> 1 <br /> PROPERTY/LOCATION <br /> INFORMATION (http://access dane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBE URRENTZQNING: ACREAGE: of property <br /> y <br /> ❑PARCEL CCt ' - ory s, R , i frontage drawn to scale. <br /> NUMBS <br /> TOWNSHIP: i, 1 , SECTI cc <br /> 6 Maw$ ru,i v\ _.(`)T 1/4: '/4'/4: i� E ❑ Driveway permits <br /> (state,county,town) <br /> ADDRESS: C e4 <br /> — r CI Sanitary permits <br /> •CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ,,�� 'L <br /> a PO k 0 e r-f far A o�t.t . A nue et Sec jl or zD Zoning District <br /> . el 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: 1 ❑ Rural Address" <br /> FIEWER EPTIC )(II- (new/existing) <br /> �� <br /> HEIGHT IN FEET: ‘ 1 NUMBER OF STORIES: (No ncluding basement) <br /> ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished a a, attached garages and above grade decks or porches) <br /> BASEMENT: o ❑ ErosionControl permit <br /> ap .S 10( V 1 TOTAL SQUARE FOOTAGE: ,' (slopes,disturbance, <br /> ��/ `/ N`� 0 C filling/access) <br /> 2ND FLOOR: 3RD FL OR: °�`J� �J,Jc) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: / /I,, '� A ) and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ /(�V V"" <br /> 0 )c/ i 3 )./< <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? nYes EINo Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres ao ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? EgYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes YjN <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blan f one) <br /> 6. Is a location survey required? (see reverse) Des o ❑Don't know <br /> 7. Is this to correct a violation? [Yes No <br /> ! l APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> v' <br /> �� 6 ,_T q 0 '" 0 C) (Continue on Back) ■ -►IL/ <br />