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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 /> �\1\Z\ � --\\ CI Zoning Status; CUP; <br /> OWNER ADDRESS (N r,Street,City,State,Zip) Deed Restriction; CSM <br /> °\�y3 ` cz-\-���5.D \\ . C :z_C:.■rc\cA.k\Nct.._ \'_ `'S Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> �StRD'�\�3� ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> -\5��2\�5 C C,4.`C\ eR Q-SD' \\K � ,❑ Site Plan including location <br /> AGENT ADDRESS C CONTRACTOR ADDRESS \J of well/septic <br /> � o\.c�-�cThN\N - <br /> (City,State,Zip) (City,Stat ❑ Setbacks <br /> R ,-o\: 7i \K- \ <br /> PHONE P e'm CI Site Plan approval from <br /> ��_C6F ----Q5- applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> \S�c�� :\>.\— \CN ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> ❑ NUMBER r+'b -- —� C> A\_dyS \• ) frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> `'�. �■ \\... \.)...--2i Ya: cw�� ,�a,�a: ❑ Driveway permits <br /> ADDRESS: <br /> (state,county,town) <br /> (3\- y3 ` o�� c_ )\-. \\ ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> ..(\ — (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ❑ Zoning District <br /> . [fhis project is a new building or structure. <br /> ❑ Permitted Use.? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> [TS- EWER SEWER ❑SEPTIC ' C)-T_CD (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> \ \ Li Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> \ \ \ \' \ 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> �"� filling/access) <br /> 2ND FLOOR: aROFLOOR: Nt.5-, <br /> �� � ) Q Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ \�\�\ 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? aril ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes atcro ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes L Nii <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# C\17,-.1D). ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ID Yes ❑Don't know <br /> 7. Is this to correct a violation? CI Yes l JN6 <br /> SE Zcc - oc7Go APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ -+ <br />