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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN R NAME <br /> / °11/1 ❑Zoning Status; CUP; <br /> ER D E S (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> /V 6 (P /Vp‘..Uj.Ej/ Aso g _p__-/io"..../J1j 1",' .....c.--7.3-/7 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 72u l — 1i'' ii() ''4u% k - ' Ct) ❑Site Plan drawn toscale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions • <br /> AGENT NAME CONTRACTOR NAME <br /> A4,14.Ily INES'T e °I,Stir. ,...r.-^/C.- q-4,0124 71 G✓C1T(d.✓17- _i✓C ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> /.? o '-,y / Z ' v. €.X /2., <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> oNE . PHONE ❑Site Plan approval from <br /> ro 6 t^ 79 16- 3 7 73 6 D13- -7'Y t3,3 7-3/ applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> vide ,E a"; c.,K e - t �1 ,, t o ,„, ID Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER 06 0b--OS-2° �Sa 'G CA.-Z J 7 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 1,,,, r 1/4: 06,..„ ,/4,/4: ❑ Driveway permits <br /> L^ % �"�ts� 7 S - (state,county,town) <br /> ADDRESS: <br /> . ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 2 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> G o,/J t-.q G sr- 3 /A,6 , :- t i ly i/b ,e-- ❑ Zoning District <br /> This project is a new building or structure. ❑Permitted Use? <br /> his project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER IEPTIC 2-° 7 o,-?- p o /I (D (new/existing) <br /> HEIGHT IN FEET: (NUMBER OF STORIES: (Not including basement) <br /> - lb Z ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> 7‘, s D /1 3 /1 ,, TOTAL SQUARE FOOTAGE: j, (slopes,disturbance, <br /> 2ND FLOOR: 3R(D FLOOR: flling/aGCeSS) <br /> 9'Y b 2 G Z-7 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ �S`�f> v0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ifiNo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes No <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) Dies ®No ['Don't know <br /> 7. Is this to correct a violation? Dies No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i -♦ -+ <br /> 545-112(4/08) <br />