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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER ilf,ME <br /> X1 cI fed, S -R0.n S-Q V\ oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> HOME PHONE 6% J C VCEVLL PHO W i E-MAIL DRESS Variance(# ) <br /> (BO% -610 - 1043 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE PHONE Ite Plan approval from)J�. <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> [t'loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER 0 7 1 a — Ogg- q a 10 -7 A • I E7( `I , y C9 .y frontage drawn to scale. <br /> TOWNSHIP: SECTION: *-O}ql, <br /> .4-e.c r,,eva Q ,A: s E 1A-14: SuJ Driveway permits A jk <br /> ADDRESS: t-� 1 (state,county,town) J" <br /> S $3 OW(14 j 6 anitary permits /v� <br /> CSM: LOT SUED ISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: �_,��,,/� <br /> Fe21a , rove _ h t„ 101 -G(` t rM t i c o . mooning District <br /> . pis project is a new building or structure. <br /> LVID'ermitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Ural A•• <br /> FIEWER • EPTIC (new/ xistin• �p W, <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) /J" to. rots <br /> Z�( d Li Ij'1(etland/Floodplain/ � <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) LI trOSIOr1COntrOl permit <br /> BASEMENT: 1ST FLOOR: <br /> j TOTAL SQUARE FOOTAGE: 1 (slopes,disturbance, rf <br /> /G Y 6( filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> /05-' L S ' view Location Survey j\ O <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ off_ and available options. <br /> (Please round to nearest dollar) ?�Od <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yeslo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes Flo ['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? SJYes ❑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 to ['Don't know <br /> 7. Is this to correct a violation? 'Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -i <br /> 545-112(4/08) <br />