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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME j I �/ J� t ` rn a n <br /> Q r01GF it /7 e/ nwji f�c yG n e l� Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Str?et,City,State,ZZip), ,/M Deed Restriction; CSM <br /> 30 5 �`-Ie,t► h Iaa e� f�Q i 5/P //y WI . 5"3559 Variance(# ) <br /> HOME PHONE CELL NE E-MAIL ADDRESS <br /> �$7 fi S.3 66 ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION an 'ncludes 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 ,� A <br /> —"' applic le township. /v <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evation of proper <br /> I) ty <br /> PARENT PARCEL NUMBER: dd CURRENT ZONING: ACREAGE: p p y <br /> ['NUMBER call-0 7/�,-J�/`9'500 0 A A —1 & ' q0 1 a el C r ej fron ge drawn to scale. <br /> TOWNSHIP: SECTIOK <br /> ,peer 1 f&(e(e L LI %: ki E %%.. SE Driveway permits t f� <br /> ADDRESS: 'J ` r (state,county,town) <br /> 30_5 T7 ^ o man L j ma r 5.ii ca j(,, WI 5`3`5.5 anitary permits p qq <br /> CSM: LOT SUBDIVISION BLOCK/LOT NJ� <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF;REVIEW <br /> PROJECT DESCRIPTION: AO e c r C <br /> fro r h1 YY�.Q�fi i rl e h y —5 t o r a B S I/ ed= no W ale r ba Zoning District <br /> This project is a new building or structure. <br /> erp' Use? . <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: il 0 n PERMIT NUMBER: ural Ad® '- <br /> FIEWER rEPTIC (new/- tsting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 0' rein l tland!Floadpl lirll <br /> Shoreland' (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ® rosion... . t ermit <br /> BASEMENT: 1ST FLOOR: �� a <br /> 7 � TOTAL SQUARE FOOTAGE: (slopes,c turbance� -; ^ p <br /> add filling/access) "0 f��tt <br /> 2ND FLOOR: 3RD FLOOR: y _ loo© SD •%f Review Location Sury <br /> ESTIMATED CONSTRUCTION COST: <br /> '- and al j C � °°, <br /> (Please round to nearest dollar) � ♦ �S <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes *lo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? .... ['Yes •i o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes 121No <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 No <br /> (C *ue on Bad() <br /> 545-112(4/08) <br />