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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER.NAM <br /> • \` \ 1/�f V \ , ❑Zoning Status; CUP; <br /> OWNS DDRES (Number,Street,City,State,Zip) <br /> 7a � c®� i,,.„-\--12_ e_oico, Deed Restriction; CSM ) <br /> Variance(# <br /> H•ME PHONE CELL PHONE E-MAIL ADDRESS <br /> �8-y3?-mss $-5X- (iO (v t. p_ —' r.� <br /> t vc11 eT�r�,.t�. / Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> GENT NAME CONTRACTOR NAME 4 <br /> N� \ S-Y;``if. l r 'ytA k, ❑Site Plan including location <br /> AGENT ADDRESS CO CTOR ADDRESS of well/septic <br /> - S P(4-'3 ttc-- 4-vu e AS 1( <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 /> n Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREA ❑ Elevation of property <br /> ❑PARCEL 7c&. c67 d6Y ; ,; �I 6_j . ,i_� frontage drawn to scale. <br /> NUMBER /'r <br /> T �P: SECTION: <br /> (n to b AW,._ 1/4: 1/41/4. ❑ Driveway permits <br /> ADDRESS: (state, county,town) <br /> CSM: <br /> ?..2e-i3 C,e t <br /> OT r <br /> b SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (c6—(-1.7 J. (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT CRIPTION: <br /> eD <br /> ❑ Zoning District <br /> . EfFhis 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 /> REWER ,EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ----a0 - _ ; J 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: ❑ <br /> ErosionControl permit <br /> TOTAL SQUARE FOOTAGE: ,l (slopes, disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 35-oo ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -∎ -+ ♦ i . ;C.> 2� and available options. <br /> (Please round to nearest dollar) / o <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies 1lo ElDon'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'? Efres �No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Jlo <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) ❑Peso ['Don't know <br /> 7. Is this to correct a violation? ❑Peso <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ -4 <br /> 545-112(4/08) <br />