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-7 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME t <br /> k A 3 t SA1 17 / ❑Zoning Status; CUP; <br /> OVVNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 595(9 AAA Hoc-Kt G -b M Z-DAiipN) I E >L-o/ 53,5(0 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (0 S-7/2- 724' ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME C NTRACTOR NAME <br /> �1e A t\j— Sal IT fi ❑Site 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-MAILADDRESS E-MAILADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL %U frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 13 E& -� L ,--„,-.)- � 1/4: A/ %IA: /� ' 0 ❑ Driveway permits <br /> / v (state, county,town) <br /> ADDRESS:CC 1.4E4- I <br /> 5 J.S(p MP\H DG R t ., M /r�, (E 535(0'0 ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> - (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: . <br /> r-3(- (Lb 5 PA4 ❑Zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: kj PERMIT NUMBER: ❑ Rural Address <br /> EWER SEPTIC � (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> / Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: q ��// <br /> (Outside dimensions including unfinished area,attached garages and above grade dec s or porches) <br /> BASEMENT: 1ST FLOOR: 1--1 ErosionControl permit <br /> ^� 4, TOTAL SQUARE FOOTAGE: 1 (slopes,disturbance, <br /> l filling/access) <br /> 2ND FLOOR: W 3RD FLOOR: <br /> Z 0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: Z2 o and available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres ZNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres LillNo ['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? Efres `®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) Efres ONo ['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 />