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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NA E J r /4-g( Q L,q, °��l'?�1, I `l',() U��-SU►/ Zoning Status; CUP; <br /> OWNER AD RESS (Numper,Stre ,State,Zip) 1....--, Deed Restriction; CSM <br /> b7V " a I 1-6,--/ t/ Stpl Pt7A47-h,,e,/ 53 Z 0 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 2r r►,cz✓)<0 h w g Thai/,cow ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT E CONTRACTOR NAME <br /> / /j'?t/-y-f-,,di-etA_T-_s" <br /> Cv �01 Pp'1'f Z.� Site Plan including location <br /> AGENT A DRE CONTRACTOR ADDRESS of well/septic <br /> (City,State,zip) (city, Zip) Setbacks kn.e., <br /> PHONE / <br /> PHONE [Isle Plan approval from�j4- <br /> O t ' 5-7p�� <br /> applicable township. <br /> E-MA LADDRESS E-MAIL ADDRESS <br /> vn o ;( S7 Cop( / ,U6I w toll loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONIN G: A REAGE: 2 Elevation of property <br /> rty <br /> 0 NM ER l {. /o `l ®1-('3 'J3 ZO ` . 3 <br /> frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> on sty( 9O . 4: ,S[ %4%: Ai r,-:- riveway permits <br /> /VA- <br /> (state, county, town <br /> ADDRESS: ?s>/-/ �C/` �`p l atary permits 'v <br /> - <br /> CSM: LOT SUBDIVISION s kjt . cBLOCK/LOT (public, private) <br /> / ;� <br /> . I <br /> PROPOSED PROJECT INFORMATION ''STAFF REVIEW <br /> PROJECT DESCRIPTION._ �-,� • <br /> IJ/14 ')17%Li i ".13 I oning Distract <br /> . This project is a new building or structure. <br /> p � g mitted Use?,: <br /> This project is an addition/alteration to an existing building or structure. , r: . <br /> SANITARY SERVICE: PERMIT NUMBER: +LJ-R'ural Ad eSS <br /> EWER r)EPTIC (new/ 'Sting <br /> HEIGHT IN FEET: q/ r r /' �qn NUMBER OF STORIES: (Not including basement) 0.-)/ tland/Floodplain/ OC <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) 'osionControl permit <br /> BASEMENT 1ST IN1/4 FLOOR: p , r ,C <br /> 11��gJffl((�J11�1 4, TOTAL SQUARE FOOTAGE: (SIO eS, disturbance ' <br /> `` ' fillip /access _ <br /> 2ND OOR: 3RD FLOOR: filling ) <br /> ( 1 G� .-R eview Location Survey/J 4 <br /> ESTIMATED CONSTRUCTION COST: d�P� 7 I and available options. <br /> (Please round to nearest dollar) .+ ♦ "_o. ♦ ♦ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies D6 DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? .... Es No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes ow( <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 to ❑Don't know <br /> 7. Is this to correct a violation? ['Yes Drib <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -* -* -1 <br /> 545-112(4/08) <br />