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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 /> � .Q0a of ve o• kit <br /> OWNER ADDRESS Number,Street igt.State,Zip) . r�j ❑Zoning Status; CUP; <br /> snQU f� �—� C ( f f Jr Deed Restriction; CSM z-O et <br /> HOME PHONE v CELL PHONE Q ;�/ AILADIDRESS n� ( �'7�� Variance(# ) <br /> 1��17 US' "' ' 41 4C rU..L'`e 4_, I Al , 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.us/) <br /> PARENT PARCEL NUMBER: 61080 CURRENT ZON NG: ACREAGE: ❑ Elevation of property <br /> ❑NUMBER 10(.00/ 17) O ( /� 6 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> SPY'. �-• ` •1/4. <br /> •1/41�: ❑ Driveway permits c0 1 <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: !�!c <br /> pc��{(J CI Zoning District <br /> ❑This 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 /> F1EWER gEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> r 2 II Wetland/Floodplain/ <br /> I AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: % ( /' <br /> �TJ ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar O Q . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes RNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes alo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes c.ENo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Efres tialo <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 ENo ❑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 />