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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com !=;2=in=27 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME L,/ I4i \ s LL-c,,` 1.11 _—_-_- -__.---._-----_--- D Zoning Status; CUP: <br /> OWNER ADDRESS (Number.Street,City. e.Zip Deed Restriction; CSM <br /> HOMEP��1 H.. 'PHONE S 0E-MAIL•�D s 3 Variance(# ) <br /> _ , , - A ,'a! t, ,t..f..t ' 7e'-c0il:I Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR InFORC,IATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 6.....r7 DJp.-g-c fl Site Plan including location <br /> AGENT ADDS CONTRACTOR ADDRESS of well/septic <br /> (City.State p) i, (City,State.Zip) D Setbacks <br /> SS ` kvA. ('`')I. ❑Site Plan approval from <br /> PHONE PHONE <br /> bQ - C,.i_&Di applicable township. <br /> "Eli_fiDDRESS E-MAIL ADDRESS <br /> I Ulf ❑Floor plans to scale <br /> '� <br /> � .}-` l A rte, � .6,01.44' <br /> PROPERTY/LOCAT',ON :!J=ORMATION (http://accossdano.co.dano.wi.usn Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING ACREAGE Elevation <br /> drawn property r scale. <br /> DPARCEL �,�1 '] <br /> NUMBER O So17OS I O•-O t 1" 2°1 ji +°� <br /> TOWNSHIP: SECTION <br /> R140,44, : ,/4,/4: D Driveway permits <br /> id - —_- -- (state,county,town) <br /> ADDRESS <br /> NC? Dk ' ❑Sanitary permits <br /> CSM: LOT SUBDIVISION 1 BLOCK/LOT <br /> 1144 1 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJEt TDESCRIPT;ONS+4' L /� \\ ` �O� Igo ] Zoning District <br /> . This project is a new building or structure. Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> _..------_------....___..--.-------.----_..---_.__._____---_— <br /> SANITARY SERVICE: PERMIT NUMBER — ❑ Rural Address <br /> EWER nEPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES (Not including basement) - -- Li 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) J ErosionControl permit <br /> BASEMENT: 1ST FLOOR 4 TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> _ <br /> --, __ filling/access) <br /> 2ND FLOOR 3RD FLOOR II� <br /> �� `f C]C' U Review Location Survey <br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ♦ ♦ ♦ ♦ �$��oo,oo and available options. <br /> (Please round to nearest dollar) 7 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes 'lo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes Ro DOon't know <br /> 3. Have you talked with the township about your project and are they in agreement? 0 e o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? U es OW <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 Iglo ODon•t know <br /> 7. Is this to correct a violation? Q1'es Llo <br /> 0 Y '0 APPLICATION MUST BE SIGNED <br /> O ' (Continue on Back) -i -i <br /> 545-112 4/08, 1 <br />