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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 /> Gle...sa Se-.4.,s+. 0 Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,Slate,ZIp) Deed Restriction;CSM <br /> `trigs C t.t. B ILK.E..rtt► S3SI cr variance(# ) <br /> HOME PHONE CE E-MNL�IDDRESS <br /> - a -3 O.. Les it - 30 leasol.Sasols4areiKer co.." fl She Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> C A DR_'�_._1I!�1 w Lit:. 0 Site Plan including location <br /> AGENT ADDRESS + ADDRE W a /, of well/septic <br /> 767 OA e-S4-. (s..:+IL tot) Setbacks <br /> (City,State,Zip) (City,Slats,Bp) <br /> PHONE PN NE C�/ _ S� 0 Site Plan approval from <br /> ( \61F3-4'3'4 applicable township. <br /> E-MAIL ADDRESS E-MA X /s� <br /> j .r ,. 114;14144: N•"M^ 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> — ..- [Eievati«t of property <br /> 0 NMBER D,497 <br /> 3a3 rrtn,3 `/V� frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> • '/a. `1 , sY. 1 ❑Driveway permits <br /> (statedounty,town <br /> ADDRESS: 6 '� ) <br /> permits <br /> CSM: LOT SUBDIVISION BLOCKILOOT (wry <br /> \a,,.4' (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: E It. <br /> la...l.k: w 64„,,, a'f X 13.` �k.,jlt, °PN ❑ Zoning District <br /> . ❑This projecrii a new building or structure. ❑ Permitted Use? <br /> Eafhis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> L E "c (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> St" of -�.`�\ ❑ Wetland/Floodplain/ <br /> �J ► 7IREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area.attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR 3RD FLOOR filling/access)liing/access) <br /> R: <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST - ♦ ♦ ♦ -I. and available options.-I.(Please round to nearest dollar) ..240418•OHO <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres 1214o [Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes Cj • [Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [2fes ■ • <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes Ego <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 i l o ['Don't know <br /> 7. Is this to correct a violation? [Yes D(40 <br /> ' APPLICATION MUST BE SIGNED <br /> (Continue on Back) -t► -► -► <br /> 546-112(4/08) <br />