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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 /> 7 IG/I� A P foi, ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> / / Deed Restriction; CSM <br /> MME PHONE CELL PHO ` E-MAIL ADDRESS Variance(# ) <br /> ,_/' f73-A I/ -_ ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑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 /> ElFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpJ/accessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ©PARCEL 06//_3s 7?7o-d /' ! r frontage drawn to scale. <br /> NUMBER C� <br /> TOWNSHIP: ,, SECTION: <br /> /%S0- S,6V1 k 9 s JS-6 i 4/ 1/4:/70's AA6-k/4'/4:SE,�E ❑Driveway permits <br /> ADDRESS: 0 / (state,county,town) <br /> 7 7 / '7UW ei e • S� O(.'. c3 °/ ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJEC DDsfRIPTION: 1 Q <br /> dd/fi tb� Q [S-f r r ❑ Zoning District <br /> . <br /> This project is a new building or structure. <br /> ❑ Permitted Use? <br /> is project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER rEPTIC (new/existing) <br /> HEIGHT IN FEET: cif `/ NUMBER OF STORIES: (Not including basement) <br /> ❑ WetlandlFloodplain/ <br /> AREA TO NEAREST SQUARE FOOT Shoreland (attachment) <br /> T: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: r--1 ErosionControl permit <br /> j TOTAL SQUARE FOOTAGE: ,+ (slopes,disturbance, <br /> 2ND FLOOR 3RD FLOOR: filling/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: d, ,`S7 •Gw and available options. <br /> (Please round to nearest dollar) ♦ '♦ • ♦ �7 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Io ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 216 <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 1 'i <br /> _=1 ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes to <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► ■ —► <br /> 545-112(4/08) <br />