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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME / L <br /> n� U QY'T 5,,fi1 ❑Zoning Status; CUP; <br /> OWNER ADD SS (Number,Stree,City,State.Zip) Deed Restriction; CSM <br /> 20539 S pr i r3 S4-ut,v iikw. 1 , O JI X 35-?9 variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> . - '---, --13-01 -332-613"7 °'-e sp. • a 4,1 L 0 ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 1.x Eu€,rc f f ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State.Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE r` ,�' �r5��i ❑Site Plan approval from <br /> &O - 7-16—_ )( I applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> El Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> ❑ <br /> PARCEL ) frontage drawn to scale. <br /> NUMBER 0411-272-6L5c-7 Q- tA /• IZS <br /> TOWNSHIP: SECTION: <br /> P 1�.Sc.r ► r55 1/4: N�i ,/41/4. El Driveway permits <br /> ADDRESS: S (state,county,town) <br /> 2U pi+IS 1 9ZJLJ51'1 0.1 Oil-• 5 3S—SP ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 6� ) Z (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> butor+v2 DLL Ic- ❑ Zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER ❑ Rural Address <br /> EWER [EPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> ❑ 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: I—. <br /> ErosionControl permit <br /> TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> X `U filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 2:2:-7 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: u �,, and available options. <br /> (Please round to nearest dollar) '♦ ♦ ♦ ♦ ♦ ♦ O 700-4 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Lives ao ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Lives 1No ❑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? Lives [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) Elves czpo ❑Don't know <br /> 7. Is this to correct a violation? [Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -. -► <br /> 545-112(4108) <br />