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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU TOMER TO PROVIDE <br /> OWNER NAME <br /> S u iir 0 k D r4 Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> a 9 ► (&)of Lt h e SOl / ' � �^'� 1 Deed Restriction; CSM ) <br /> HOME PHONE CELL PHONE V E-MATo ADDRESS <br /> �uh�1� �S 7 I Variance # <br /> 6 8'%86 6 S or' A 3 '4.!._2 • Aid Er9ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFO aMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Si Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS o well/septic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE PHONE ❑Ste Plan royal from <br /> plic e township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> loor plans to a e <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevati of property <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: II <br /> ❑ <br /> NUMBER ©(p , 0" 6.5.3-70)31- 1 ■.3 , la front e drawn scale. <br /> TOWNSHIP: SECTIO <br /> ` j 1/o. �o 1/4,/4. S E ❑ Driveway rmits <br /> h '� (state, unty, awn) <br /> ADDRESS: r ' <br /> A ! ►D (10 Ot bed Pc €. ❑Sanita •ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> j(laubl. , private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTI N: , 0 /' <br /> Fro h-� ?0 r c n e,C td )� / 0 la !Zoning District <br /> . <br /> This project is a new building or structure. Permitted Use? <br /> This project is an addition/alteration to an existing building or struc ure.N SANITARY SERVICE: PERMIT NUMBER: ❑ R al" <br /> KEWER DEPTIC ( ew/e !sting (! <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not i eluding basement) V <br /> 1 tland/Floodplain/ <br /> l horeland (attachment <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) IN4 <br /> BASEMENT: 1ST FLOOR: Ero ionControl permit <br /> //t'� ' TOTAL SQUARE FOOTAGE: 4, (s pes,disturbance, <br /> (J�9 ing/access) <br /> 2ND FLOOR: 3RD FLOOR: Q <br /> Review Location Suuey" <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ 3 o 0 O 1 <br /> r J <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Res <br /> fKlo ❑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? ❑Yes No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank none) <br /> 6. Is a location survey required? (see reverse) Ekes No ❑Don't know <br /> 7. Is this to cprr ❑ 2110 ect a violation? Yes lo <br /> j ! r <br /> 4 t ° i P APPLICATION MUST BE SIGNED <br /> 545-112(4/06) <br /> ,� 0 (Continue on Back)a Q S 0 4� <br />