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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 /> T tsi fifes El Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City.State,Zip) / Deed Restriction;CSM <br /> '-2S22... W t-line K4ty i at 5-176 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> _Z57_510 f CE / .-6,0*, ❑Site Plan drawn to scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME / <br /> ccCi‘t J C4"�' ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> /i/( GI/celstielt <br /> (City,State,Zip) (City,State,Zip cc J ei_ 6..,..e. G✓ 'r J❑Setbacks <br /> PHONE PHONE q ❑Site Plan approval from <br /> ' <br /> &C,T— C 3 53y/ applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ,�,( , 6 <br /> 5c t 6aoe2crt r . C c'; ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> tillid ;)11 1/4: 1/4'/4: ❑Driveway permits <br /> ADDRESS: j� �/�,, (state,county,town) <br /> -CP-2 - U. f eJi�`-)ve ' """ rili ail � 3 7/3 <br /> 0 Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> $$r Cie— L f 4v--z. ❑ Zoning District <br /> . ['This project is a new building or structure. <br /> ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER PEPTIC (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: ❑ <br /> ErosionControl permit <br /> TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ .. and available options. <br /> (Please round to nearest dollar) .p U V ?6 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes l ' ° DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies no ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ["lo <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 Do ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ["lo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ ■ -i <br />