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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 /> �Ga'f.(2' oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 339M Deed Restriction; CSM <br /> Q,,,,, ///[ f Variance(# CI? ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Elr- ■0 6,---71 <br /> Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> .�eo.,^ c4,ti—� DPI.--'y5 C 1 ❑Site a ' cluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS O tiCSA <br /> I T3 \-J i ,i I w 4ee S� 'lei-- <br /> sr,Zip) i (City,State,Zip) SetbacksbeV + <br /> PHONE• PHONE ❑Sit- _ .n a.• oval from <br /> � 7 T -P3 S a•: .-..'etownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> IZF,IPOr135S o scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p pert <br /> ❑PARCEL �r frontage drawn to scale. <br /> NUMBER 06/o —X3— /)-O / 1� 3 ', J <br /> TOW(\pJ$\)HIP: SECTION: 1 <br /> v Yyl‘N 1�: S l-J 1RA: !yews its <br /> ADDRESS: (state,C ty,tOWn)ma . <br /> Itary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> Ir;' •rivate) <br /> i <br /> PROPOSED PROJECT INFORMATION F REVIEW <br /> PROJECT D RI,Pilggl: Xe M.0 / fr. �i�/ istrict <br /> FK � o/ 0 <br /> . ❑This project is a new building or structure. ermined Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Rural Address <br /> NEWER [)EPTIC ne exis in <br /> HEIGHT IN FEET NUMBER OF ST RTES:at including basement) t <br /> r r.nd/Floodpiain/ <br /> AREA TO NEAREST SQUARE FOOT <br /> Sho - = , attachment) <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> II rosionControl permit <br /> BASEMENT 1ST FLOOR: <br /> 3 l itO +, TOTAL SQUARE FOOTAGE: j (slopes,dlsurbance,* , <br /> 2ND F�00 O 3RD FLOOR: s�g,_ <br /> filling/ cress) `.y <br /> \CT eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) —0. and available options. <br /> N <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [ ` ❑No Don't kk o <br /> 2. Is there a wetland or floodplain on or near the property? es ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes i <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 ENO ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -♦ <br /> 545-112(4/08) <br />