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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App <br /> PROPERTY OWNER INFORMATION. <br /> ` CUSTOMER TO PROVIDE <br /> O •tER NAME <br /> auk..1 4 `..)a v-e.1 L-, L e 1 vn n 1,- . ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) .i, , Deed Restriction; CSM <br /> o?q b1-1 1..)-etvv-I Wt-Ovid — Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> &Cfc3--8"13--`1 el.?0 0013 --5b1- L(1-7 8 So,vtitl'-.A .Le i mey- ;k,Loi c.tnsiv, ov 0 Site Plan drawn to scale <br /> AGENT,INFORMATION CONTRACTOR INFORMATION --:. and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 1,00 nets U t e(AJ ex,Cl ld e r ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1 0--)`-) Woods,Jiel„ C,r,c, e <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> 5%1')(A_I 1s1"M t LAIL 536Sc1 El PHONE PHONE U.1 <br /> Site Plan approval from <br /> LOT 531 3 - X301 Co applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> . n Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.darte.wims1) : Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> 0 PARCEL Oa II)1 oS 11 -, 144- t i 9, otl 3 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> OUt VN 1!'1 r ,/. 1/41/4. El Driveway permits <br /> ADDRESS: (state,county,town) <br /> a u Di-1 14eAm m.ovid (Z 01 .9m-4-14404 L W--1 <br /> CSM: LOT SUBDIVISION BLOCIVLOT El Sanitary permits <br /> 99 1 0 I (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> STAFF REVIEW <br /> PROJECT DESCRIPTION: {� <br /> • <br /> (R i\.-i 4C.on Od- Cl s-eots OVA Aooww' ❑ 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: <br /> ❑ Rural Address <br /> r)EWER 134EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> 3 1 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: ❑ ErosionControf permit <br /> 00)(-1 4, TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, : - <br /> 2ND FLOOR: 3RD FLOOR: <br /> '' 11 <br /> filling/access) <br /> °�a `E ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ` and available options. <br /> (Please round to nearest dollar) —° —° L.081 C1�(�.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ONo EDon't know <br /> 2. Is there a wetland or floodplain on or near the property? es No EDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes fNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes 1No • <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) QYes gi■o ['Don't know <br /> 7. Is this to correct a violation? []Yes ONo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -0 -•' <br /> 545.112(4.081 <br />