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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU-TOMER TO PROVIDE <br /> OWNER NA ME <br /> d., //�SG gE /A/ <br /> ill Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> / f/LZZ 0� 6,' �35e7 Variance Restriction; CSM <br /> / Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> %5-/4' 4,`,5-5-- 574- 293/ -him. may,pr/. C Crs ` Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION 'and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> fie ' fggi L Gs7n/L7 i0/N1 040 Icr4,EsivJ4YIG/ •I "ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS •f well/septic <br /> PO, Z. / miS. <br /> (City,State,Zip) (City,State,Zip) Mil S tbacks <br /> -o ova 636-2. L <br /> PHONE PHONE 11 ite Plan approval from <br /> SAS, oyo>s' pplicable township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> c-3wi Cc.9/ Cam— loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 0.5-61641-�8 5'907, / / 3_o rontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 1/3y`y j-2/fg A/l/ 1/4: A/a/ 1/41/4:42 -76' <br /> /4,/4.4 /7 Driveway permits <br /> ADDRE (state, county, town) <br /> COLY kb , <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> 044/SS / (• •lic, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCR1RTIQN: <br /> V k.., \i.) eCast © CC .5Y X L :oning District <br /> . RThis project is a new building or structure. IcC ,U v`� CI Pe ted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> l ddress <br /> SANITARY SERVICE: PERMIT NUMBER: -ura /. <br /> %:-- 'EPTIC /3- 2o1-1_ e30/0 7.- ( ew existing) <br /> HEIGHT IN : T: / / NUMBER OF STORIES: (Not including basement) <br /> /�J ? / (L�) R U \ ^etland/F zdplain/ <br /> AREA TO NEAREST SQUARE FOOT: Ot a _A horel d (attachment) <br /> (Outside di ,1 .• - luding unfinished area, attached garages ove gra a decks or porches) <br /> _ ErosionControl permit <br /> BASEMENT: COP 1ST FLOOR:/4-.553 0GO (slopes, disturbance, <br /> ��6 Z,27, v. 5 I TOTAL ARE FOOTAGE: 4, ( p <br /> 2ND FLOOR: /� 3RD FLOOR: ttfw/�� �� ,I� -? filling/access) <br /> /t� ,4 Z294/.j ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: *try n�� and available options. t <br /> (Please round to nearest dollar) ♦ -�► ♦ ♦ �( V � J <br /> fl /, ,IOC <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ]No EDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes 9No ODon'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 EINo <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) fees pNo ['Don't know <br /> 7. Is this to correct a violation? �� 0Yes ®No <br /> 5 %� APPLICATION MUST BE SIGNED <br /> 545-112(4/08) W.c() ^ A O 9P 0 (Continue on Back) ♦ -∎ --∎ <br /> R,c. <br />