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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAt A() t\ s LL.C,Lov(v;� ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number.Ai City,State,Z c 1 Deed Restriction; CSM <br /> ly71 I-L s� J�o0►c�T�J L,& -�3.5 Variance(# ) <br /> HOME PHONE CELL PHONE E-Mit tylDRE§S <br /> 0)--^ O 1 Q ° 1 \'' ‘ ` ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NA E n 11/, CONTRACTOR NAME <br /> AVJro 14 _ ❑Site Plan including location <br /> AGENT ADDRES CONTRACTOR ADDRESS of well/septic <br /> 14-n. i-Loi St <br /> (City.State,Zip) i (City,State,Zip) ID Setbacks <br /> SA-0 ^1 VS; 53 ► <br /> PHONE J PHONE ❑Site Plan approval from <br /> (DDQ - 50q -£Sgo4 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION y(http://accessdane.co.dane.wi.usn El Elevation of property <br /> ❑NUMBER 05a�o510' alt'MO -1c NTa ING: ACREAG -�� <br /> PARCEL frontage drawn to scale. <br /> TOWNSHIP, ,t�� • SECTI N: <br /> �iKK)) o,�d\�, � 1/4: '/a'/a: ❑Driveway permits <br /> (state,county,town) <br /> ADDRESS. i <br /> 14 S7 O Ci.Y 0 PQ^ j SUBDIVISION BLOCK/LOT -- ❑Sanitary permits <br /> CSM: �191 LOT I (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT D-SCRIPTIOnnN: /� <br /> �i M. K. Sir 4-- ,��\1 gdi ISO 3 Zoning District <br /> . This project is a new building or structure. <br /> 3 Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. 3 SANITARY SERVICE: PERMIT NUMBER: 3 Rural Address <br /> 1EWER r)EPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> t1 3 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) <br /> BASEMENT 1ST FLOOR: U ErosionControl permit <br /> j TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> - filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 3, 00 0 Li Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ J D and available options. <br /> (Please round to nearest dollar) Si 0D,QQ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes nNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Nlo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Wes alo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? glYes jlo <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 NI o ['Don't know <br /> 7. Is this to correct a violation? ❑Yes 0 o <br /> V � <br /> 0<., V° <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) �' 11 i (Continue on Back) <br />