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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ! <br /> �AMe-J Sit Id 2 ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) /� / <br /> c7u4 4c,,o/c el gri50 uyr, L✓,T 57 rz Variance e(#fiction; CSM ) <br /> HOME PHONE 'CELL PHONE E-MAIL ADDRESS <br /> , I ! Z21 7 r Z2( ' 7 nM p St Lviz ap/rir4/W}" ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER tCiSbq' 2$3'"1451-6 1R1-1- LA ►`F,•1• <br /> TOWNSHIP: SECTION: <br /> Orel des.-- 1/4: '/4'/4: ❑Driveway permits <br /> ADDRESS: _/ (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> .1)01y,e44- _ ❑ Zoning District <br /> . <br /> his 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 FIEPTIC (1/oNC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> gyp' / ❑ 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) ❑ ErosionControl permit <br /> BASEMENT: ./ 1ST FLOOR: <br /> NOW( 30 x ,, TOTAL SQUARE FOOTAGE: ,l (slopes,disturbance, <br /> y filling/access) <br /> 2ND FLOOR:A/ - 3RD FLOOR: <br /> '`�o C NoNC 1 t0' <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: <br /> $ <br /> and available options. <br /> (Please round to nearest dollar) -10. -1. ♦ ♦ ".. -0. 5-000,00 <br /> .lg$1.50 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ONo ❑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? Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? EYes ❑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) [Yes No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -i <br /> 545-112(4/08) <br />