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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME Ge S r <br /> IZO9 C- Y EIS SR ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 3.SS0 t-k�4`/E`/ t STc�v lsl}'�'0 v--)k S3q Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (SOB 073 a-o'i0 boo 7Qy9 rob.-et's:sre 9Ma",' ,co M ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ <br /> NUMBER ot}b� OW ( �7- 2 _ -7 R j /,S/S'- frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> PL SANT- SPv0✓(,S Z8 1/4: AAA) '/%: IVC ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT CI Sanitary permits <br /> �� couNn2-Y A RE <br /> Er- <br /> PROPOSED private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESC IPTION: <br /> c*tt -/ QA-T►D 9-EMont"Z- ❑ Zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> Xi This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER ASEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER F STORIES: (Not including basement) <br /> IV/4- N/ - ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: iCO 43 Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: r--, ErosionControl permit <br /> to' x t0' = ltd t¢ 4 TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ Q q �� O o and available options. <br /> (Please round to nearest dollar) $ (i <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes A No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes .No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? AYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ,allo <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 JNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ANIo <br /> APPLICATION SIGNED <br /> MfU^ n. r (Continue on Back) ♦ <br /> 545-112(4/08) <br />