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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> �OWNER NAME S `, 1\ \,, <br /> Y"LA t�\S�r\�� Amr\Ov ` S ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number, City,State,Zip) /� a \� C�2 Deed Restriction;CSM <br /> H-1\\N �c -'S\PHONE \. f" ��1,(\\D Y , +W� -3 ?� 5� Variance(# ) <br /> Y6\\' ❑ <br /> t. 1• • -.-1,l it. y a\ a i a . N.` Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> .CCE— ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS it of well/septic <br /> 14S'CI \i■CS.V`S\6 Z. R\ " <br /> (City,State,Zip) ..( (Qty,State,Zip) t 1 ❑Setbacks <br /> W-IONE \1 PfONE I 1 El Site PI a rom <br /> cc appli I ship. <br /> `(AIL ADDRESS \ F�(l MAILADDRESS 1 <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (h ttp://accessdane.co.dane.wi.usl) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER `�1 I °1�jg 'Us\ -c\b s A\ -_\ frontage drawn to scale. <br /> TOWNSHIP: SECTION: , <br /> d66,\\ � w <br /> %--}-A S`. <br /> 1/4.N� '/4'/4: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> —1 .% \•10\-\ \(\k---.Q---,6. N\,ac\\eh \f) 1W ❑Sanitary permits <br /> CSM: L T SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: (\6, \l%\AA < , Z I`\A/l lye ■ <br /> _ \\c\\1n \,N Q w Vn 1 c.3‘ c\UyS c1 \r �(y1 w z\Y\ ■(\ ) ❑ Zoning District <br /> . 0This projct 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 /> 1/ FIEWER EPTIC \5--3&k - c t-' (new/existing) <br /> ��1 HEIGHT IN FEET: `^^ surz_ NUMBER OF STORIES (Not including basement) ❑ Wetland/Floodplain/ } <br /> (tVV�, 1f , cr,t n ` I Shoreland (attachment) <br /> AT EARS T SQUARE FOOT: CA� �� <br /> (Outside dimensions including unfinished area,attached garages and ove ggrraf, e d\ s orr porches) ❑ ErOS(On�.Ontr01 permit / <br /> BASEMENT: Z.11-y 1ST\FLOOR: <br /> o.....- 4, TOTAL SQUARE FOOTAGE: (slopes,disturbance, <br /> c ems'd� ��� >C� fillinglaccess) <br /> 2ND FLOOR: 3RD FLOOR: l `� �S <br /> 1.) ` ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: d� t� h and available options. <br /> (Please round to nearest dollar) -► ♦ ♦ ♦ ♦ ♦ V w� <br /> d <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ■1 k o •.•n't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes b • ■"II on't know <br /> 3. Have you talked with the township about your project and are they in agreement? 15ifes II No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 1 10 <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 o ❑Don't know <br /> 7. Is this to correct a violation? :Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />