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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWKR NAME <br /> J l -114n2- 101 t l-N7FFIvi r I ! Zoning District <br /> OWNER 1�- 7 (Nu M Street, <br /> FIT/,City,State,z!`U P I T)!11 J t W I r"VI W6rmitted Use? <br /> PHONE �7 E-MAIL ADDRESS <br /> /I�/I — q% -- r �i 9 % . Zoning Status;CUP; <br /> AGENT INFORMATION I CONTRACTOR INFORMATION Deed Restriction;CSM <br /> AGENT NAME CONTRACTOR NAME Variance(# ) <br /> �IGh(1r r�,y l� �T�UL�16T J <br /> AGENT ADDDR S q� rCOONTRAC OR ADDRESS Q�� 1Q Site Plan drawn to scale <br /> coo a ?Rio -v/o ' "/�l P - I ` ! . / and includes dimensions <br /> (CA,State,Zip) I � (City,State,Zip) <br /> r (r�� C�Ll Alci, WI (-2 -lb A-1P-4 PU ;WI G Site Plan including location <br /> PHONE / b'I --V I ' PHONE /�-69 -11 I-I of well/septic <br /> E-MAIL ADDRESS E-MAIL ADDRESS Setbacks <br /> )ern re &�‘ti m- env' <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Site Plan approval from <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: applicable township. <br /> ❑ PARCEL 001/08 1=Oil -s <br /> NUMBER �/7l(l 1'� '(J'>V V <br /> TOWNSHIP: txG .1) SECTION: ;21Rural Address <br /> Cg /�l 1/<: '/41/<: (new/existing) <br /> ADDRESS: <br /> (O G M f\TZ P-P j P e 1 W 1 / /2-g Floor plans to scale <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> ■ levation of property <br /> PROPOSED PROJECT INFORMATION frontage drawn to scale. <br /> PROJECT DESCRIPTION: 12.:e.-12-(47)*WI in# )N/I fl • .- i ),//,I r ..Mil 11111L1 ( /G • It 0• „1 l0 ,4 u 40,4 IA V [ALL v 4 e ❑ Driveway permits <br /> . ❑This project is a new •uilding or structure. (state,county,town) <br /> ,This project is an addition/alteration to an existing building or structure. <br /> /at anitary permits <br /> SANITARY SERVICE: �,{ PERMIT NUMBER: ublic,private) <br /> ❑SEWER Jt71 SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 1❑ 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) ❑ rosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> 1 slopes,disturbance, <br /> rrV� + TOTAL SQUARE FOOTAGE: , pe <br /> VZ fling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 1 la `6?'& r I T� <br /> ' Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ --I. and available options. <br /> (Please round to nearest dollar) $ril 1)DTP <br /> ( fl-t-)rt p2-6-je4u-) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes ti(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 34 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? LI Yes )2(No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► <br /> 545-112(1/08) <br />