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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENTtO.Weti•App# <br /> PROPERTY OWNEILINFORMAT.ION I.„ ,WWW`r ,x SE.. w M CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 1 [VD P Q iit if A6- 1.3.C- ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City te,Zi ) <br /> j 5‘ c� wo Aa /u t/ �q Variance Restriction;CSM ) <br /> HOME PHONE C L PHONE E- ADDRESS rn <br /> II-881►-a -9M ..t-g.,95-7-751 jAS Urfih? �% AOL ❑ Site Plan drawn to scale <br /> AGENT.INFORMATION CONTRACTOR-:INFORMATION Ntj43 and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> `)AmeS w--1- V j ev ❑ Site Plan including location <br /> AGENT ADDRE / CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) LI Setbacks <br /> La pA mi. 53539 <br /> PHONE aa PHONE ❑ Site Plan approval from <br /> —SOL1-aaclo\ applicable township: <br /> E-MAL.ADD ESS E-MAIL DDRESS <br /> � Ep Q Am �� ❑ Floor plans to scale <br /> PROPERTY/LOCATION<INFORMATION':;(http://acce.ssilane.co.dane.wLits/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURREN Z ING: ACREAGE: p p y <br /> ❑ PARCEL / LI LI AGvP J frontage drawn to scale. <br /> NUMBER Oba- O la--303-9'06?-0 v <br /> TOWNASEC ION: <br /> b i _ 1/: ,/,/: ❑ Driveway permits <br /> (state,county,town) <br /> ADDRESS:/3v h/4 ; <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> - . STAFF REVIEW <br /> PROJECT DESCRIPTION: J j r <br /> IL X 16 (),-1-11,-41/ btAl t( I c/\ Zoning District <br /> xl Li This project is a new building or structure. L Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. _ <br /> SANITARY SERVICE: PERMIT NUMBER: --I Rural Address <br /> ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 0 f':. I I Wetland/Floodplaini <br /> T� Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: LI ErosionControl permit <br /> i9a , ,, TOTAL SQUARE FOOTAGE: I (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> LI Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) 35e� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes alo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes allo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes 14 No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? WYes ❑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 ragNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► —► —.- <br />