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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER N E_ '�(. ' ,1 <br /> �I P t 0(�p S 1-`'G- — A 11-No n ( (1)p( ❑Zoning Status; CUP; <br /> OWNER ADDRE S (Number,Street,City,S te,Zip) 1 <br /> PC St' Deed Restriction; CSM <br /> �� �l ( Variance(# ) <br /> HOME PHONE CELL PHONE E-MAI ADDRESS <br /> •• C'-1SCi 7o CU 32‘ • \ IA CIO •fc h❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> N ( �oN)es- LL c_. 0 Site Plan including location <br /> AGENT ADDRESS CONTRACT 9R ADDRESS of well/septic <br /> 7aa 0 t111( ct . <br /> (City,State,Zip) (City, te,Zip) I ❑ Setbacks <br /> PHONE PHONE El Site Plan approval from <br /> 6Qci, a2 0 -/cy applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> [' Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> PARCEL frontage drawn to scale. <br /> NUMBER OGIV- (92-0323-C• R--Z' o.4((i'F6 Ac- <br /> TOWNS P: SECTION: <br /> v A r\ 1/4: <br /> .1/4-1/4: ❑ Driveway permits <br /> (state,county,town) <br /> ADDRESS: _ <br /> a32-0 04(k(J 0cA- 1 I G(, I i Sanitary permits <br /> CSM: LOT s SUBDIVISION BLOCK/LOT (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 2pp tq C L. ' c(5-h, n3 clIP6 C. ❑ Zoning District <br /> . <br /> This 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 /> FTEWER 1'REPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ 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) I—, ErOSIOnCOntrO[pemllt <br /> BASEMENT 1ST FLOOR: <br /> j TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ d �� 0 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? �E]Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes-----ENo EDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ..TYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Elves----_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----ENo ❑Don't know <br /> 7. Is this to correct a violation? Elves — No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />