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• <br /> - ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWNS ME <br /> ii FP/ �IZo 7/-��f ❑ Zoning Disfrict <br /> OWN/EF�ADDlRRESS (N�u1m-ber,Street,City,State,Zi ) <br /> b /(� l l v�I,v t P ' /d 1 7�S MCC t �/L 1� S 5 S� ❑ Permitted Use? <br /> PHONE )J E �j, <br /> 6 e: f _I — 0 0 u F F �/ r P, ,o (ow) ❑ Zoning Status; CUP; <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Restriction, <br /> A NT NAME CONTRACTOR NAME <br /> rt vi F7�>zS ow �- ... Variance(# ) <br /> AGENT ADDRESS CONTRACTOR ADDRESS ❑ <br /> Site Plan drawn to scale <br /> 5 03 4/1/VI 14 t= Mt — <br /> and includes dimensions <br /> (City, ate,Zip) 1 ,, (City,State, <br /> P N 40.San- 1 V� �� ❑ Site Plan including IOOation <br /> 6"vK) (_ ! (2c../�!}l PHONE-� of well/septic <br /> l <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 7�IZSo N it 1 E-lzsow�E�H �j a', awl �� ❑'Setbacks =:" <br /> PROPERTY/LOCATION INFORMATION (http:/laccessdane.co.dane.wi.us/) ❑ Site Plan approval from <br /> PARENT pPA�RCEL NU BBE�R: r� ZONING: ACREAGE: a Ilcable tbwnshi <br /> ❑ NUMBER e) i1 �0�'1�9/'‘07'Q �� pp p. <br /> TOWNSHI SECTIIO�N`:� j ❑ RUral Address <br /> v/l Frill fZ/C" 0;2 1/4: �(� 1�41�4:c lI/ <br /> ADDRESS: (- ; (neW/exlsbng) ' <br /> 6 ( w,n CSI A t / 1) ❑,Floor plans to�sicale <br /> CSM:09 LOT SUBDIVISION BLOCK/LOT <br /> ❑ Erevation of property <br /> PROPOSED PROJECT INFORMATION frontage drawn to scale. <br /> PROJECT DESCRIPTION: ,(f <br /> � O ///L7 it w,r r ❑ Driveway permits. a new building or structure. (state,county,down) <br /> This project is an addition/alteration to an existing building or structure. <br /> ❑�Sanitary permits <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> ❑SEWER ❑SEPTIC (publicpnvate), <br /> HEIGHT IN FEET: 1 i NUMBER OF STORIES: (Not including basement) ❑ 1Neflarid/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR. <br /> /Si0 eS dlSturbarice, <br /> 4 TOTAL SQUARE FOOTAGE: j, \ p ; i. <br /> 2ND FLOOR: 3RD FLOOR: filling/access), <br /> 0 Review"Location'Survey <br /> ESTIMATED CONSTRUCTIO COST: $ 1 000 <br /> (Please round to nearest dollar <br /> '� "� '� and available opttons. <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. There is 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? es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes I:3 No <br /> 5 This project is associated with a rezone/CUP/variance (petition/appeal# ) (leave blank if none) <br /> 6.. Is a location survey required? ❑Yes ❑No CI Don't know <br /> 7. Is this correcting a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(1/08) <br />