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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWNER NAM ` <br /> id EIte►1 KI It�11,, en \) f' .Joky. Wens, <br /> Zoning District <br /> OWNER ADDRESS (Nur4 er,Street,Cit Zip)W //oy i / fA Vil AtA / v <br /> UV-I- P rrfltted Use? <br /> PHON ( E-MAILARDR 1 S <br /> A i_I i ' .) % ;Girl .! . Q �) �`('� P Zoning Status;CUP; <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Restriction;CSM <br /> AGENT NAME CONTRACTOR NAME Variance ) <br /> -511ANSC F-xx FAce <br /> AGENT ADDRESS CONTRACTOR ADD ESS ( ❑ Site Plan drawn to scale <br /> Jv J� • and includes dimensions <br /> (City,State,Zip) (City rate,Zip) ey <br /> 53 1 ❑ Site Plan including location <br /> PHONE PHONE l of well/septic 14- <br /> E-MAIL ADDRESS E-MAIL ADDRESS ❑ Setbacks <br /> PROPERTY/LOCATION INFORMATION (httpJ/accessdane.co.dane.wi.us/) ❑ Site Plan approval from <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: /� <br /> ❑ PARCEL 9 applicable township. <br /> NUMBER Ii <br /> TOWNSHIP: SECTION , r <br /> i 1 5 C AE ❑ Rural Address <br /> 3 /a: /a1/a: (new/existing) <br /> ADDRESS: <br /> ❑ Floor plans to scale <br /> CSM: ��� LOT SUBDIVISION + BLOCK/LOT <br /> ❑ Elevation of property <br /> PROPOSED PROJECT INFORMATION frontage drawn to scale. <br /> PRO 'T DES IO w1/f' e �'U n r )l '/tomi <br /> ,/ <br /> W_(J(�/ (' ❑ Driveway permits <br /> . YThis project is a new building or strutele. (state,county,town) <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> ❑ Sanitary permits <br /> SANITARY SERVICE: PERMIT NUMBER: (public,private) <br /> D SEWER ❑SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ❑ 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) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ $ 5,'do 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 L No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes Ni 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 ❑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 ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes EiNo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(,;oa) (Continue on Back) —► ■ —► <br />