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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 /> L'P l xP-01' " 2/E ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction; CSM <br /> 1117 S1 0-,9-A4 PR-WE Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (,0gzig1 ->02-b 4 (at.-S'( -t PSor 0 cn to,,W L •c_e>i<A Q'Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CON CTOR NAME <br /> 5o 7 fD L 4/4SShJ �4'7; t,c.)C 0-Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 445 k, <br /> D <br /> (City,State,Zip) (City,State,Zip) o Setbacks <br /> PHONE PHONE Site Plan approval from <br /> (,Gp�j y-it LI-rte( 9 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ,- (0-iT-.o 'DK c•ce 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑l Elevation of property <br /> PARCEL frontage drawn to scale. <br /> NUMBER 6 7 a 7-2 6 3- 1.9:>( -3 g <br /> TOWNSHIP: SECTION: <br /> IDu'M W Gx-e.yS Pc0.7,)5 SE '/4:S4J '/4'/4: z,%"" Erbriveway permits AA <br /> ADDRESS: (state,county,town) <br /> 34# 6r law <br /> r [I]-Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, private) <br /> PROPOSED PROJECT INFORMATION , STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> NE,,J �,,NGC.f- -F,0944(t1 l-,is ❑ Zoning District <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 /> FIEWER 2EPTIC /3- 2D/7 - D 6`f o 4' (new/existing) <br /> HEIGHT IN FEET: t NUMBER OF STORIES: (Not including basement) <br /> 33 - O ❑ 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 I—, ErosionControl permit <br /> ...Q1.4/.... I Q�Z , TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> `-T U filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 9¢ <br /> Li �� NA- 7'6' - 7 I U 3 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) f 1 Dd, ipL/d <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ao ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Ekes ENo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [v]Ses No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 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) Ekes I-P"O ❑Don't know <br /> 7. Is this to correct a violation? [Yes ❑P46 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -* <br /> 545-112(4/08) <br />