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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTO ER TO PROVIDE <br /> OWNER NAME . --_ <br /> OoLlf■ 0. oakA oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State, Deed Restriction; CSM <br /> ! ONE0 EI`CELT6Wo�i WI- s�� Variance(# ) <br /> HOME PHONE 1 E-MAIL AD R S <br /> S3Lk'11S8 a •z.wtw.Q (L1SC. e_A,v IZ,s.itscrG drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Plan including location <br /> AGENT ADDRESS ;., CONTRACTOR AD ESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE ❑Site; -', ap•roval from <br /> ap• 'cabl: township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> r F •or : -ns to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) •ro ert <br /> PARENT PARCEL NUMBER: CU RENT ZONING: ACREAGE: II - atl►I roperty <br /> ❑PARCEL O Cf)0f 9S-351-1 -6Q I-) fro .ge brawn to scale. <br /> NUMBER W J <br /> TOWNSHIP' 1' SECTIO <br /> l7L)v Vic- 1/4: 1/41/4: ❑ Drivew- p- mits <br /> ADDRESS: (state .. nty,town) <br /> )- )' SC7 L M El Sanita , .=rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 0)/4 0)/4 , (pu. ' , •rivate) <br /> l r i <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Eck_ e...4 ms 1 b kA /if aZarrmg 'strict <br /> . ❑ his project is a new building or strucure. <br /> project Itted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: / Rural A •• -Ss <br /> FTEWER {EPTIC / (new 410 HEIGHT IN FEET: .C: j NUMBER OF STOR S: (Not including basement) <br /> e ...plain/ <br /> ,t: attachment) <br /> Shor- chment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> Ero-'onCo►trol permit <br /> 14 of 0 j TOTAL SQUARE FOOTAGE: 4, (slope 5 sturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> L - <br /> f '•• ac•-ss) <br /> -I�C Revie Lo ion Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and a ble options <br /> (Please round to nearest dollar) $ a^1 k� t <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies 4.o EDon l <br /> 2. Is there a wetland or floodplain on or near the property? Ekes l o ❑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? Ekes 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 /> 545-112(4/08) <br /> (Continue on Back) —► ■ -♦ <br />