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ZONING PERMIT APPLICATION www.countyofdane.colll SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME /../..a <br /> / /��J� _ ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> WO 1 �vrr1 �1 f SP 1 r� J34-1 <br /> / , Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS II <br /> iNc—79c Z_ 4/y)1 iceman 7/to 200 6 d all- i ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NA <br /> l/- �j- -c,vr ❑Site Plan including location <br /> AGENT ADDRESS CONT CTOR ADDRESS of well/septic <br /> 770 y S-, -.1.« 4 e CJl AV— <br /> (City,State,Zip) (City State,Zip) ❑Setbacks <br /> LA0ri0`14 Sss � <br /> PHONE PHONE ❑ Site Plan approval from <br /> iiii —7 1 S ? applicable township. <br /> I E-MAIL ADDRESS E-MAIL ADDRESS . Gd'''-� <br /> ill 1 , A /% aoC,j 444,, • ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> ,,PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> Y`I N EL <br /> lLJ NUMBER 1 l` L e3 i S frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> /f(‘114 I 1"," ,/4. ,/4,/4: ❑ Driveway permits <br /> ADDRESS: (state, county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 4 > PS f'd! 7 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / <br /> a6 I ❑ Zoning District <br /> . <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 (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: Erosion Control permit <br /> 1 TOTAL SQUARE FOOTAGE: j (slopes, disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: / <br /> 1 X �).0--,1Q ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ M�� and available options. <br /> (Please round to nearest dollar) Fj i OW <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ONo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes MNo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? es No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es �C 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) ❑Yes ®No ['Don't know <br /> 7. Is this to correct a violation? ❑Yes pNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ —► <br /> 545112(4/08) <br />