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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 /> go9 r- & Rebecca 8aSS ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> I c15 3 C-4 H k),� P B Ve Tena W I 6 35 9 3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6ta ala - .3448 ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME . i <br /> VVt3 sf S i 4., Now,/S, hi c_ we Sfsi-d-e [ w,e.S l►n c-. ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 30 6 �4 e_e_ j v St, 30C, A c.cide yr,y St-. <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> 014- /-k r-e f Gtl/ 5-357 - t3'i f- 140 re.6 14 l 53S 7 Z <br /> PHONE PHONE ❑Site Plan approval from <br /> (,0 S' ‘43--) --)7/a (j0% 43-1-7-7 / a applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ix,pSts,da h_ N. 26 ,,.,Afe , -oj- weSfSiettkt -4S0mAk, net [1 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ONING: ACREAGE: <br /> ❑NUMBER 001060a° 263-96`10-0 1- -1-- 6 , $5 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> "re,w rl b4' Vert)r'O 2(., '/a: '/s'/a: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 1 C\5 3 C+k.I 1-11.0y P B Verbr•k (As ( 5 35 q 3 <br /> El Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 12. 56(1 I (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ber{ bu:klek11 (An SfirL.,c-+i t,-, Zoning District <br /> . lIhis 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: PERMIT NUMBER: Rural Address <br /> r) W <br /> EER PTIC (new/Ckitt ) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) <br /> r ' o " / ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1 ST FLOOR: r-, <br /> ErosionControl permit <br /> '44 e + TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 768 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ --► ♦ ♦ OGO and available options. <br /> (Please round to nearest dollar) 1 S) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des F. o ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Oyes M o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Oyes M o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? EYes No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# 99 S.3 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) [Yes M o ❑Don't know <br /> 7. Is this to correct a violation? Des 31 o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ - <br /> 545-112(4/06) <br />