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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER IN1FOORMATION CUSTOMER TO PROVIDE <br /> a�[J On ,-.1n/C., [! Zoning Status; CUP; <br /> OnvE/$AD SS (Number,Street,City,Sta Zip) �� Deed Restriction; CSM <br /> l[JJ\l, OTC I? e x1 - �/"�� Z� Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL DDRE S <br /> 6 O5-21 - .'0 eA>e Apie5d'iqCCi/-Coil ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME C1TRACTOR NAM n <br /> 7b t ( r/u ei` , e. J c Site Plan including location <br /> AGENT ADDRESS MONTRAATOR ADDRESS o ell/septic <br /> (City,State,Zip) (City,stzip) Dave Gar f 2 Setbacks <br /> PHONE 6 Hale e �/ ave Vag 3527 <br /> PHONE / ❑Site Plan approval from <br /> 6 og-2161-'$l 03 applicable township. <br /> E-MAIL ADDRESS E-MAIL AqDI RESS1 , 1 <br /> GJ Cyr h Oi lesci •mad.ezoi Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CU ENT ZONING: ACREAGE: P P y <br /> ❑PARCEL 01)( 14_151'14 °4 <br /> J� 1"b ) /` u 7g frontage drawn to scale. <br /> NUMBER V V t J 1 / [ <br /> T SHIP S CTION: N�1/4 Sr <br /> , , Driveway permi <br /> �,sr �� : �a�a: <br /> (state,county o n) <br /> ADDRESS:72-1 Z 0L)rf-c' -1) <br /> x- ' -1-- C-6 SS ❑Sanitary <br /> CSM: LOT S- DIVISION A BLOCIQLOT <br /> It divf�1(f ®' (public, pri ate <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION!: � ,/ <br /> Aka) 5 44� 4 one_ ❑ Zoning District <br /> . P 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 /> FIEWER 51;EPTIC t 3 20 r 130-Z2* (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 2" ❑ Wetland/Floodplain/ <br /> 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 /> Z O bb 67 ' rZ 1 TOTAL SQUARE FOOTAGE: y (slopes,disturbance, <br /> eet - 3RD FLOOR: ) / filling/access) <br /> PaILL�JeCk-l(f S196 V ❑ Review Location Survey <br /> ESTIM T CONSTRUCTION COST: <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ "♦ $32§-Opp and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres ENo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Dies P]No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Elves 10NNo <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) gi(es ❑No ❑Don't know <br /> 7. Is this to correct a violation? [Yes Egklo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(aioa) (Continue on Back) <br />