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ZONING PERMIT APPLICATION ww.countyofdane.com SUPPLEMENT to Web-App# <br /> w <br /> 1 <br /> PROPERTY OWNER INFORMATION OFFIc E usE or <br /> OWNER <br /> Zoning District <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 10 1 gar L ..S . :. ata Fr;c,s(cinl ia- .539,_ ermitted /i <br /> PHONE ••- <br /> 7; . 1 • • �L/ <br /> c0 -3yg -5019 gZoning . <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Restriction; <br /> AGENT NAME CONTRACTOR NAME <br /> Tcrr 0(Son .� <br /> AGENT ADDRESS CONTRACTOR ADDRESS 4 ❑ Site Plan drawn to scale <br /> Ill <br /> WDaocl State, and it ludes dimensions <br /> (City,State,Zip) ��.�•= <br /> PHONE FQ Lt R:0 Cr Li' 53(13g- All CI Site Plan including location <br /> PHONE <br /> ADDRESS ADDRESS <br /> ❑ Setbacks <br /> VIII <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) i■ Site Plan approval from A... <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: C livable township. <br /> / <br /> j PARCEL NUMBER 01... • -a' -. 818-1 12- 1 • I-118 -PP P• <br /> TOWNSHIP: SECTION: q ��� <br /> Rural ..- - (J <br /> B r; S}n I a�1 '/4: $E '/41/4: wt.J (new -xisting) <br /> ADDRESS: '. <br /> Clog �'!'ci;r,e V c v Dr - _ CI Floor plans to scale il "`-f <br /> CSM: LOT SUBDIVISION BLOCK/LOT 10 ' 0 �.n 77 <br /> 38 Pr-c. r�c U,w 146 h s -Ist Ih. f'on Elevation of property / <br /> PROPOSED PROJECT INFORMATION frontage drawn to scale. 2 5- <br /> PROJECT DESCRIPTION: <br /> (ns+Q(1 la I x Iy I rear Acck IA/ c I J <br /> KDriveway permit <br /> • own Af 4 <br /> . 111 This project is a new building or structure. _ <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> 4iii•- _ <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> ❑SEWER SEPTIC <br /> HEIGHT IN FEET: 3/f i /` NUMBER OF STORIES: (N.t including basement) CI yyetland/Floodplain/ <br /> ! Shoreland (attachment) _ <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ilErosionControi permit i , cl- <br /> BASEMENT: I 1ST FLOOR: ` <br /> I /lJ 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, t <br /> O <br /> line/access Ir Q J <br /> 2ND FLOOR: 3RD FLOOR: U / 0 fr <br /> d Li Review Location Survey / <br /> ESTIMATED CONSTRUCTION COST: and available options. I <br /> (Please round to nearest dollar) --0. 4 $ gas-.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes N No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? Li Yes ®No ❑Don't know <br /> 3. Have you talked with the township about your project? •Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes II 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 iii No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes U No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ ♦ —► <br /> 545-112(1/08) <br />