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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 /> 3G-Vv.e.S A Lek-pp Zo7irig Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Dyed Restriction; CSM <br /> .IS 7 Door Cry L S4-0„3 k+on LO % 53S89 Vpriance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ka8-S75"..94(.7 J la• ►a7 S7a L 0,-k oe• CO M Sate Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION end includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> acrytes A Le--pp 40,(,,beiry “1\cr• ❑Site PO-Mau-ding lopation <br /> AGENT ADDRESS CONTRACTOR ADDRESS of•' e11/septic Non <br /> x757 poor Cree tack W 6o(a Couri g' EG. f <br /> (City,State,Zip) (City,State,Zip) 13/Setbacks. <br /> S- b...10‘ ,-*Or LZ 1 53589 Per �cev lc. lJ 53g5�( i <br /> PHONE <br /> PHONE ❑ Site PI9tl proval from <br /> kb 8.- 57S- S4 '7 ( 3g- giy4•3�35 applipable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS ! <br /> SIG,• • a7S7 € akoo•W ry, /Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y/r <br /> ❑PARCEL frontage drawn to <br /> NUMBER OS ID aa <br /> D - I -gaoo-k, C <br /> TOWNSHIP: SECT • (� <br /> RUA-1 1/4: 1/41/4: N F ❑ Driveway pe mits <br /> ADDRESS: (Stateye6-linty,toy ri) <br /> 3333 SA - ��y l 3 S' o.x). �4on w t S3S89 ❑ Sanit ry rm s 1 ;�CSM: LOT SUBDIVISION BLOCK/LOT d <br /> (pub• , private) �_.. <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTI N: / <br /> (oO X I'a� col 4 S+urase. PO lc gay h ❑ Zoning District <br /> . This project is a new building or structure. <br /> ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or struct re. <br /> SANITARY SERVICE:' j PERMIT NUMBER: ❑ Rural dre <br /> EWER EPTIC ) (new/e fisting ', <br /> HEIGHT IN FEET: 9 NUMBER OF STIES: (Not incl ding basement) j <br /> I �1Netland/Floodplain/ <br /> Shoreland (attachmen <br /> AREA TO NEAREST SQUARE FOOT: �� <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> vo 1 TOTAL SQUARE FOOTAGE: j (slopes,disturbance, LT' � n <br /> 2ND FLOOR: 3RD FLOOR: /� ^. fling/access).:, <br /> -.1 'ie<) ki <br /> Review Location Survey 1 <br /> ESTIMATED CONSTRUCTION COST: r �� <br /> (Please round to nearest dollar) -i -4► ♦ ♦ 4 ♦ $ SO?t 000 and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ,s lo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? es '' o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Elfres ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies ❑N <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 o ['Don't know <br /> 7. Is this to correct a violation? [Yes o <br /> ,..4 —. <br /> Of ! APPLICATION MUST BE SIGNED <br /> "� (Continue on Back) ♦ ♦ -i <br /> 545-112(4/08) 3 <br />