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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNA ME //'� <br /> , �7 x GQ ❑Zoning Status; CUP; <br /> OWN DRESS (Numb r,Street,City,State,Zip) Deed Restriction; CSM <br /> /19-0 Z JIG L ?Y-, 5 -60 #9UN, LizAr 5-35-Y7 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> .•. — 7ZI- ' o ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> y t'1 bec 7/6a,v57- y c ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR AD RESS of well/septic <br /> 0836 �r �z. /Z- r <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE 1)-)6 s3 ❑Site Plan approval from <br /> 66 r S'7 aj zr applicable township. <br /> E-MAIL ADDRESS E-MAIL A RESS <br /> ' <.rc eat, 2ii nn t • 4. <br /> N4-er'•.S ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessuane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMB CURRENT Z NING: ACREAGE: <br /> ❑PARCEL <br /> UM EL / .3,92_35.-0 20) / frontage drawn to scale. <br /> NUMBER 0 bi` Z ! / ��° <br /> TOWN IP: SECT";Z ,/4. ,/4,/4_ ❑ Driveway permits <br /> AD Es ,/1 (state, county,town) <br /> /820 5iey6 - 2`J( ?4 �� El Sanitary permits <br /> C M: LOT SUBDIVI ON BLOCK/LOT <br /> tilt°.7 —1. (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> j4 , t 1/40-c_ ❑ Zoning District <br /> . Ohis project is a new building or structure. <br /> ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: ,,�,( PERMIT NUMBER: ' Li Rural Address <br /> FIEWER VXSEPTIC 1 i h p (new/existing) <br /> HEIGHT IN FEET: �� NUMBER OF STORIES: (Not including basement) <br /> J Z ` ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> 4-( <br /> ❑ ErosionControl permit <br /> 317,-/G.) 2 66 b�Z�` „4, OTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: ( <br /> filling/access) <br /> 89°5-4Z ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ / and available options. <br /> (Please round to nearest dollar) $ La�ID 0 c7 0 <br /> f <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes to ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ,]No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? 12F-es ❑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) Ekes ®No ❑Don't know <br /> 7. Is this to correct a violation? Elves ,lo <br /> APPLICATION MUST BE SIGNED <br /> 54e-112(4/08) (Continue on Back) <br />