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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN NA <br /> rc C-' (2 ec' ning Status; CUP; <br /> OWNER ADDRESS (Number, Q <br /> ( e,Street, ;State,Zi ) <br /> 1 C/ pd V' p v Q„ Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Site drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site ' cluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of /s tic <br /> (City,State,Zip) (City,State,Zip) tbacks <br /> PHONE PHONE II Si n approval from <br /> alcble township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evation of property <br /> PARENT PARCEL NUMBER: CURR TZONING: ACREA E P P y <br /> ❑NUMBER C (M 3S 1 $�t'1G� /'"3 / a7/ . � , frontage drawn to scale. <br /> TOWNAg$g$HI : SECTION: <br /> 1 oI 1/4. 1/41/4. El DriveW its <br /> ADDRESS: y„ — ( e, coun town) <br /> S / 6 - -ry Pere its <br /> CSM: LO SUBDIVISION BLOCK/LOT <br /> Alt (publ,ate) <br /> PROPOSED PROJECT INFORMATION S,1.- FF REVIEW <br /> PROJECT DESCRIPTION: <br /> S IN b U C n onin istrict <br /> . ❑This project is a new building or structure. <br /> P fitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> [)EWER [)EPTIC (new/- 'sting <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> (.) W,;11 '�� 1 ,j ec,�A S ❑ Wetland/F oodplain/ <br /> Q g ore an. - achment f <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ,. <br /> BASEMENT: 1S LOOR: ToS10nCOntrOl perm) <br /> j TOTAL SQUARE FOOTAGE: j (slopes,disturbance, ;A, <br /> filling/access) 0/ J <br /> 2ND FLOOR: 3RD FLOOR: Z G O 0 ,� j <br /> h�j Review Location Survey <br /> ESTIMATED CONSTRUCTION llar)COST: <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ and avails options. <br /> WO <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No EDon't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes fNo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Elves ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Elves ❑No <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) Elves ENo ❑Don't know <br /> 7. Is this to correct a violation? Elves ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />