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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 /> IC C\ G ztfs'g ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,Atate,Zip) Deed Restriction; CSM <br /> -"1f 35 6hd2L,1cl f 0 c-h- Variance(# ) <br /> HOME PHONE CELL PHONE f E-MAIL ADDRESS <br /> 905— Id-) -4 No 9w1_ cx,v1 k o,&,3J -411 ' Cow\ ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> V2,11,-.01(1.1 e.1{-e,, FN 50 t..- ci c (C C ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 5 p,,--, SS LA S WW1) ridetA <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE G� �+ 531 ❑Site Plan approval from <br /> (cC8 ??3 cp r g applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> KO _,rev, % CJV-41( I • Gtiti+-, ❑ 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 bg/o7o8_ o3.1-144),-Q A. - I - r7 88 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> m idU ao 1/4: 5 1/41/4. S tN ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> —V-935 6hc)IrSl, OAtsti Ci"• Vim+—crA I\r-si I c?593 ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 7a Spy )-,.Ito - (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: � I <br /> ,J � l Z IS C i[A LI Zoning District <br /> �"33his project is a new building or structure. LI Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: LI Rural Address <br /> FIEWER (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 5 ❑ 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: 1 ST FLOOR: I-1 <br /> ErosionControl permit <br /> Lji 46 ,, TOTAL SQUARE FOOTAGE: 1 (slopes,disturbance, <br /> �� filling/access) <br /> 2ND FLOOR: 3RD FLOOR: `'► <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: Q © °S- and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ 38 C.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ►f No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Mes I o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ---Ekes ❑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 Etlo ❑Don't know <br /> 7. Is this to correct a violation? [Yes _Eto <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />