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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 /> Cfkr Ss(I'h e _ C c . r‘_ . -t--rGk_SSrvi c& oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zi ) Deed Restriction; CSM <br /> C,13p Co(�0 y l r 1 OI'eg Cr'rt. w� g'3 s? s- Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6 d q sL3-0 go.) '3 L&,dde r • k 5 p Q . 1/1,Gvb" ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> rte 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 /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) a Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ['PARCEL G 5pq —07Li—8776-5 A - i F--)( __'L frontage drawn to scale. <br /> NUMBER `'"I <br /> TOWNSHIP: SECTION: J"s <br /> a (��o, 7 ,/4. 5g- ,/4,/4. 5E raeway permits fJ <br /> ADDRESS: (state,county,town) /� <br /> 1 GDC.t �'� anitary permits tJ Y <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 6 • c) (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: /// ,r <br /> G c4-r c. e a 1 % 3 Uc cesidQ,(n\ S'let o�Q_� t Zoning District <br /> . ,This project is a new building or structure. UU t Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ©-fiural Ads ress <br /> [)EWER [EPTIC (new -xistn• <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Q M-e�h -I-- ❑ W and/Floodpla n/ <br /> horeland.(attachmen <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) L <br /> BASEMENT: 1ST FLOOR: osionControl permit <br /> 11- 1 TOTAL SQUARE FOOTAGE: , (slopes,disturbance, () <br /> 2ND FLOOR: 3RD FLOOR: (� <br /> filling/access) <br /> ?6 q Dice-view Location Survey .0 5 <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -•► ♦ and available options. <br /> (Please round to nearest dollar) $ /Ui w U <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres .E1No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes pNo ['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 ['No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) ► •lank if none) <br /> 6. Is a location survey required? (see reverse) � QNo ['Don't know <br /> 7. Is this to correct a violation? . es No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -9 -► <br /> 545-112(4/08) <br />