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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 /> `.1 of L." �S 1 tJ Vt E I''S' ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> S ?3 O 0P∎V, C 4 -O'1E R-Zt>R--t> ( Ye%ovt�T ■Xott3613 1 wz S3572- Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 4-11.-t-3 13-534-3 S- f-e. R. 1 t,IDE L S •Go V © Site Plan drawn to scale <br /> AGENT INFORMATION i CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> CLe k Q-.`I' S vow) 1Nb- COP-1? Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> Iq0 PAbt-I ST .st--t <br /> (City,State,Zip) (City,State,Zip) ea Setbacks <br />` \\M P-43 t,a 1%, v..31. 5 35 t13 <br /> PHONE PHONE t ❑Site Plan approval from <br /> c O vg- 'S 9-100 applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> rr%SONA il.,.{ ei CLeAve aL,16D)N6• ©Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdano.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER:OSe7-e4y-98p CURRENT ZONING: ACREAGE: <br /> ❑PARCEL GS m 039R6 - , _ *X� Lf,9 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> '1 1Z 1r4 9-4 5 (To 5 tJ R0-7 0 Oct '/a: S e '/a'/a: S t ❑Driveway permits <br /> ADDRESS (state,county,town) <br /> 730 OAY CsCI-o jt L / YNA ow,rr KoRs3, wS 3gs71-- <br /> CSM. A LOT 1 SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> JJ _► I (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> CONSz2uCT1()0 0'F ACCESSOR-Y MAILS,1t+* ❑ Zoning District <br /> . 1E This project is a new building or structure. u Permitted Use? <br /> U This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: .__ ❑ Rural Address <br /> EWER PEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1 g ' ' " j ❑ 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: T FLOOR: 1,—, <br /> ErosionControl permit <br /> t`'/A (3_4)(64 15 343 Sc,{-F , TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) <br /> N q N/A ' S 3k, sl,44 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: t ♦ ♦ ♦ ♦ }'S- Orb — and available options. <br /> (Please round to nearest dollar) 4T j <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes JNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? LYes Jlo LDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes t !o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Elves ao <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) LYes Jlo QDon't know <br /> 7. Is this to correct a violation? Dyes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ -► -r <br />