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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C STONER TO PROVIDE <br /> OWNER E / <br /> OWN�D �iV 1�!'► !�� il Zoning Status; CUP; <br /> yS6 (Number,Street,City,State,Zip) <br /> �� �� Deed Restriction; CSM <br /> / ' ��� V dance(# ) <br /> HOME PHONE CE L PHONE E-M• 'DDRESS (2, 7/"1". C o M <br /> (O '7y a99� ?I O / ?� oo , ",d 5 hoT -c h, h7 ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT ME CONTRACTOR NAME O r to d1 L — <br /> �'.,��/ /�' g �,r M r t'A 51ar-c, 0 L <br /> •l�« r Ite Plan including location <br /> AG TAD RESS C NTRACTORADDRESS of ell/septic <br /> i"a. //PO' 7 4 <br /> (City,State,Zip) (City,Sta e,Zip) Set acks <br /> al-;...7...o iv n W•S /�Q` to-G,vs w 'S <br /> PHONE �J P,� PHONE ite Plan approval from <br /> C,O b 7,3 a,°1�S 60g ,570 -- 7Si_ app' able township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> / o ••r o-n./s A ,fi, & * ft,., Fl r plans to scale i. <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL MBER: G ,,_p RRENTZONING: ACREAGE: j� Elevation of property <br /> ❑PARCEL 03V/0, 0�v 5i - O50- E_ + G! �V <br /> 1 frontage drawn to scale. <br /> NUMBER i <br /> TOWNSHIP: SECTION: <br /> / !�2-0r-0--ki 1-� 35-`� '/4: 1/4'/4: iveway permits Wr <br /> ADDRESS: (state,county,town) <br /> 6 6 1 Hwy ?9 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits(pu.ic, private) Iv <br /> PROPOSED PROJECT INFORMATION ST F REVIEW <br /> PROJECT DESCRIPTION: <br /> ic) / C �� <br /> 11 Zon' g'District <br /> This project is a new build' g or structure. ermined Use? <br /> This project is an additio /alteration to an existing building or st u tur,. <br /> SANITARY SERVICE: PERMIT NUMBER: Q R l Adp <br /> FIEWER EPTIC ( w/e sting) <br /> HEIGHT IN FEET <br /> 0, f NUMBER OF STORIES: (Not i cluding basement) I <br /> / etiand/Floodpiain/ <br /> AREA TO NEAREST SQUARE FOOT: 0 <br /> Shoreland (aftachmen <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit , <br /> / 9[� ,, TOTAL SQUARE FOOTAGE: 1 (Slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> i9afilling/access) <br /> ' <br /> D Review Location Survey V <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ , / / and available options. /ec <br /> (Please round to nearest dollar) y L� / <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Ye'No ['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? s QNo <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) Elves ['No"EilDon't know <br /> 7. Is this to correct a violation? ['Yes�SNo <br /> ,46 Li', APPLICATION MUST BE SIGNED <br /> (Continue on B <br /> ♦ <br /> 545-112(4/08) ( Back) --► <br />