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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App It <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Poi,�3 °- L-w1& L '".L.' oning Status; CUP; <br /> OWNER AOjRESS (Number,Street,City,State,Zip) _ _� Deed Restriction;CSM <br /> T S& & noth t-' (, 1 PrA �-4 1 WI 53531 Variance(# Jc{c�01 ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> s— Sf� 57Y- 695b . al i.Ace -a '`1 .c."- 21,site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and Incl .- .'mensions <br /> AGENT NAME CONTRACTOR NAME <br /> cc5 Dpi--b ( ;b ihikr fiviws m -ite Plan including lo ation : IC <br /> AGENT ADDRESS CONTRACTOR ADDRESS o well/septic <br /> 706 (Soni• L- ) <br /> (City,State,Zip) (City State,Zip) etba ks <br /> HONE PHONE Site Plan approval from g(/_ <br /> 303--C1.6 4/ (, ,, b--, apoliicable township. ," <br /> E-MAIL ADDRESS E-MAIL ADDRESS �r e <br /> s& ?r thy. lie- ,te5, ,llA, .`,A & loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) � <br /> PARENT PARCEL NUMBER: + qq CURRENT ZONING: ACREAGE: XEIQVation of property <br /> NUMBER 055/©$11— 12 " 9 -O —' 9 2 fronts .drawn to <br /> TOWNSHIP: SE TION: 4 <br /> "rj uk.:„„1 ok y,�`ul� 7/ 1/4: e '//: S veway permits ‘t <br /> ADDRESS: (state,county,to. n) <br /> LUG S� j?r pet ' Lc ,;-G r � > if <br /> I D `1 t C S 0- C��C �r am ary permits � 0, <br /> CSM: LOT SUBDIVISION BLOCK/LOT T 1 ' <br /> Sg DCCy.kf,S woo 2S+ A r, ((public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> e to ^ne, cam) ' QO CCk a rrt G arc/() ___ ❑ Zoning District <br /> . his project is a new building or structure. <br /> ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER 4TIC ,-- — Ai —c c c c (new/existing) <br /> HEIGHT IN FEET: /,' NUMBER OF STORIES: (Not including basement) <br /> 23 �'T / ,0 Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑'ErosionControl permit <br /> 4, TOTAL SQUARE FOOTAGE: ,l (slopes,disturbance, <br /> 2ND FLOOR: ' °�3RD FLOO filling/access) <br /> N/A- Ali 3 0 cLo I 04 ❑ Review Location Survey . 4 <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ a60, �r�� and available options. <br /> (Please round to nearest dollar) lam/ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes [ lo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? DYeso ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? s ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes ElKo <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) s ONo DDon't know <br /> 7. Is this to correct a violation? DYes DC <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —. <br /> 545-112(4108) <br />