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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN NAME 0 /^ <br /> U�v-e 0 C Ji o & I & ( ❑Zoning Status; CUP; <br /> OWN ADDRESS (Number,Street,City State,Zip) <br /> / cc, ((�� Deed Restriction; CSM <br /> Pplo� 7 CT�1/ t�a� !J� ' Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS D d <br /> CP° -Site- ;7c Y _ ur -. 6) 1-045. NUJ' - ❑Site Plan drawn to scale <br /> AGENT INFORMATION i:ONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> S e ( F ❑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.usn El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> /4: 1/41/4: ❑ Driveway permits <br /> . , C 1 ///'''���ADDRESS: i ( `)c�r o hc.N . <br /> CSM: LOT `\ SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> C F c C a r 10 71 e.r 2')\13° ❑ Zoning District <br /> . This project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> {)EWER [EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES:'(Not including basement)f......$) ❑ Wetland/Floodplain/ <br /> l,..f 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: f--1 ErosionControl permit <br /> 1( -Q 0 <7. cf. 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: t to <br /> Ito 00 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: $ 1 U and available options. <br /> (Please round to nearest dollar) ♦ ♦ -� ♦ ♦ ♦ jj <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres E4No ❑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? Wes No sur <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ❑No Z w . - <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) t,,,,) ({ <br /> 6. Is a location survey required? (see reverse) Ekes 'lo ❑Don't k <br /> 7. Is this to correct a violation? ❑Yes po <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />