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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAM <br /> O�� (e r5 �- Wing Status; CUP; <br /> WNER ADDRESS (Number,Street,City,State Zip) _ <br /> ys Q F / s^ s..-^6- Deed Restriction; CSM <br /> �/ u �� �4' � u- � �.1 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADD ESS <br /> Gig 3.2 0 2 23S Scr ...t__ +'a. 6e" e_ 6,9`h4{.f C Site P an drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION an includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site ' cluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of se tic <br /> (City,State,Zip) ,�/ (City,State,Zip) (backs <br /> PHONE PHONE ° `-- L„J S. Plan approval from <br /> pplicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> Ryffoor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> ❑PARCEL v■ q/0 G J0-0Q�4 -4 S .3 , 445-- frontage drawn to scale. <br /> NUMBER <br /> OWNSHIP: SECTION: <br /> u,.l h '/4: -S� '/4'/4: Ni3 rmits <br /> ADDRESS: (s co town) <br /> L/`f3 /3'v,4 S k ❑Sanir 4.ermits <br /> CSM: LOT c7.2 SSUBDIVISION ifs A BLOCK/LOT (p • i , •ri,:te) <br /> .ff `,r,.- { 437e:„. lc <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 6v4,sft�c o,. 0 4 A 4oas� 4 �:�,� ii4e�c sx��4,' vse/ 6� LoningDistnct <br /> . <br /> This project is a new building or structure. ermitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: II Rural A•• ess <br /> NEWER r)EPTIC the •• <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> .,•. ••ttachment) <br /> '' Shore an• <br /> t <br /> / Vci, <br /> AREA TO NEAREST SQUARE FOOT: t� <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) y OSIOnCOntrOl permit <br /> BASEMENT: 1ST ST FLOOR: <br /> 0-1 110 l �0-7�F7 , TOTAL SQUARE FOOTAGE: 1 %slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR:_ filling/access) <br /> P eview Location ey.... <br /> ESTIMATED CONSTRUCTION COST: and available do . <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ �'1 S 0000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No ❑Don't knt <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? ❑Yes 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) Lives ❑No ❑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(4/08) <br />