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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> DRIER NAME <br /> hob 3., Q2,-.\:)Go ❑Zoning atus; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Re tri • n; CSM <br /> 11\`)cl n\\�0u X c.,--c m�FFI?-uP,+.“; -3-r S3S�--t. Variance ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6vK -22cys-c,O - �p�-� S3SS .@ `JC.\\()J ❑Site Pla dr n to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and incl es dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Pla • cluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s ptic <br /> (City,State,Zip) (City,State,Zip) ❑S b cks 4_ k.__ea K <br /> PHONE PHONE ❑Site i a a• = from <br /> apps .b : U ns ip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> [' Floor plan t scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of operty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ <br /> PARCEL 66'0 ^\63-ati$S-01 frontage n to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 1�4. ,%I A. ❑ Drive Ql i . <br /> ADDRESS: (stat (c i,, •wn) <br /> CSM: LOtT1 SUI4DIVISION BLOCK/LOT ❑SanlI• l'•.4 its <br /> Lk rJ `Sp .L L.-)`"'`� (pu. c, •••ft/ii- z <br /> PROPOSED PROJECT INFORMATION STAFF R 4 EW <br /> PROJECT DESCRIPTION: <br /> Cam•�S-,.-c. C_c>o ❑ Zoning 6i ,'et <br /> . <br /> This project is a new building or structure. <br /> ❑ Perini•-• Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Li Rural i •• - <br /> DEWER [EPTIC (new/e 4S 1 g) <br /> HEIGHT I FEET: NUMBER OF STORIES: (Not including basement) <br /> eiA <br /> eta ❑ Wetla d ,. to'lain/ <br /> Sho °-ttachment) <br /> AREA TO NEAREST SQUARE FOOT: 1f <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ Erosion o• .ol;permit <br /> BASEMENT 1ST FLOOR: .), <br /> j TOTAL SQUARE FOOTAGE: 1 (s10;:S, .e•, rbance, <br /> filli •/-:fsN <br /> 2ND FLOOR: 3RD FLOOR: 2 <br /> a`A 7 k ❑ Revie r •'w,,on urvey <br /> ESTIMATED CONSTRUCTION COST: $ 2r......1090 <br /> and a : - • •ptions. <br /> (Please round to nearest dollar) <br /> L <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ? o ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? III es kl4No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? OM es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes tjaio <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) ['Yes 1�' o ['Don't know <br /> 7. Is this to correct a violation? ❑Yes [- to <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />