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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME t� ,��� <br /> Cep v Cff er-T t g Zoning Status; CUP; <br /> OWNS A R SS (Number,Street,City,State,Zip) <br /> Deed Restriction; CSM <br /> -5-q4 it, J E go Mao Fv,tee- 3717Sy ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ' -7 eg .7 - .- • 16/ G; , O • 6, a • 1 C • 1' G' Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION a d includes dimensions <br /> AGENT NAME ,% CONTRACTOR NAME <br /> MAILIT�/ InA.C7-ew,t�. - Q�9GI7--y .fT(0,40. -ham- Site Plan including location <br /> AGENT°fbDRESS CONTRACTOR ADDRESS -well/septic <br /> eQ aax / - o. d' ox / 2 <br /> (City,State,Zip) (City,State,Zip) tbacks <br /> MT, f f o e r -rf 5 7 7— Mr'v as ,r--.y-r--7r- <br /> PHONE <br /> PHONE Site Plan approval from <br /> (O ° i„ 7 ? g _ 777 & O NI _ 77Q -777Y applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> F or plans to scale <br /> . . 'i • • i <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> ❑PARCEL <br /> f ntage drawn to scale. <br /> NUMBER 06b7- 062- 2/05; b 49—1 T7 <br /> TOWNSHIP: SECTION: <br /> s(1l'4 6' , 'a i f I0 1/: A/ w 1/41/4: /,,'W Driveway permits <br /> ADDRESS: � (S te,county,town) <br /> J 4C%1/ 3y G Z f O Sanitary permits <br /> CSM: LO* SUBDIVISION BLOCK/LOT <br /> ! (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> (of T/L H c t' ,�•In/ G--� ,G,gy1A/G y AA et-c, 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 4.7 0 C 7 . p o 1 o 2, (new/existing) f <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> r/ <br /> Z ❑ Wet n J dplain/ <br /> Shor attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FL OR: <br /> Er. e -- trot permit <br /> Z Q6 �/ y,3 t 4, TOTAL SQUARE FOOTAGE: IF (S)*' ,et,-t rbance, <br /> 2ND FLOOR: ( 7 3RD FLOOR: d flllln� access) <br /> 7 8 6 Z ❑ Revie Survey <br /> ESTIMATED CONSTRUCTION COST: tl and ava�etions. <br /> (Please round to nearest dollar) ♦ -► -* ♦ $ r tO� ID p O <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres ZNo ['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? PnYes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes ITINo <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 71No ['Don't know <br /> 7. Is this to correct a violation? Elves po <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -* -0. -♦ <br /> 545-112(4/08) <br />