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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 /> p04C11, SoPiCojv.t-1 ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> aaay Cvt-Y._G►2t_ou bog, tow,gitt oh,� , ... Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (20e.-4 cA-Ce 10 0 and r .S..Lo+Ji�'@' P I toy,' ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> R!c., 14 Altai 0N Sirs bx4,_ (Z,rrtodc,(Iso lilt . ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3..o' RAIL-L-1 go Po Fax E <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> S PrA ine , (/-1-- Co f h ed& w� ';33a7 <br /> PHONE PHONE ❑Site Plan approval from <br /> (A)B-53S-0 '75 SA.vx_ applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> AArborl Q BSI VW e crlorS Ilk 5s ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL UILe/O(o( -(� '-1- /-f 3�" frontage drawn to scale. <br /> NUMBER p-/Ex <br /> TOWNSHIP: SECTION: <br /> C -I5TI,'1-I'- (9 Cil 1/a: 5(,0 1/a1/a: .St,1 ❑ Driveway permits <br /> ADDRESS: (state, county,town) <br /> �6'. .`( cV G,► .tV k3f?., Pcm0 12to4� i,--T <br /> ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 00.7c7 MLA/L.= — (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> MALE (ZL?L' -C Q i=ZIC ❑ Zoning District <br /> . <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 /> FIEWER [EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ 'Wetland/Floodplain/ <br /> . Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionContro('permit <br /> BASEMENT 1ST FLOOR: <br /> TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: J 2cs filling/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ /��COQ <br /> and available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ENo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes fNo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes ENo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies 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) ❑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 />