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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT Web-App <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> I i___aaVi U 07 re I f ed— n Zoning Status; CUP: <br /> CANNER ADDRESS/�"Nu/mb r,Street.City,State.Zip) Deed Restriction; CSM <br /> 1 cP�/0 / i / or) L4 LU`1 �'�/V/�' _/ WI__ S35-?o Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6bP- .Y7-3d'Lf 40, -at/ L ') (t1-PX93 . al) ∎Nil n Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME I CONTRACTOR NAME <br /> ` i1 &v Q.. Fel lei U Site Plan including location <br /> AGENT ADDRESS I CONTRACTOR ADD ESS of well/septic <br /> 1 0WV b 4/Fen- Ltvi <br /> (City.State,Zip) (City State Zip) - ❑ Setbacks <br /> 17Ck 1r/r x,01 3 35?1 <br /> 'RHONE PHONE U Site Plan approval from <br /> b 44.22--3/2J- applicable township. <br /> E-J;AiLADDRESS E-MAILADDRE <br /> I r'� o 1 f4),c! cJCa O(. (;o0Aa ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.cadane.wi.usn n Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING ACREAGE <br /> ri NUMB R 09 i f-a 901'di tiq-® R ia_9 f_ _ , l��j' frontage drawn to scale. <br /> TCVJNSHiF SECTION <br /> I t3(1 SToL, 1/4: /V W 1/,1/: MA.) ❑ Driveway permits <br /> oo� ss — (state, county, town) <br /> �M LOT SUBDIVISION ';BLOCKrLOT <br /> ^ n Sanitary permits <br /> J / i // 74141 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION <br /> I j e dd/J/0ti -1 Zoning District <br /> [ is project is a new building or structure. <br /> J Permitted Use? <br /> '4 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE PERMIT NUMBER: U Rural Address <br /> EWER EPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES. (Not including basement) <br /> I /7 Wetland/F000dplain/ <br /> F S� Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> EASEMENT 1ST FLOOR ErosionControl permit <br /> 5 7 1 TOTAL SQUARE FOOTAGE: 4, (slopes, disturbance, <br /> 2ND FLOOR 3RD FLOOR filling/access) <br /> c7 <br /> j Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ 0, 0 U O 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? ( Yes No ❑Don`t know <br /> 2. Is there a wetland or floodplain on or near the property? Y- es No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? j_ es No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? nYes y,No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> S. Is a location survey required? (see reverse) _Y- es LNo ❑Don't know <br /> 7. Is this to correct a violation? nYes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ - — <br /> •45-''2 14108. <br />