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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 /> ,._) 0 c + cv` S di ; -_/,�, <br /> - ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Stott,City,State,Zip) Deed <br /> Restriction; CSM <br /> - 1 r0 v 'T r c I r- 4,AJrSvn kii-z c3 f/ # ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 241- 3 s 1—06 9► 21,1 3s -1 -cC y/ 7.,—, ,YS t -'-' t ^Icy I. e o tom► ISISite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Sfw1- -iv F/A;fii ioi' Stv c-4, LcC VSSite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 32.0 co, I ;, hti,yRd <br /> (City,State,Zip) (City,State,Zip) MiSetbacks <br /> _ _ _ <br /> PHONE PHONE 8��� L ❑Site Plan approval from <br /> b 4/S 3 - yy_5-1 applicable township. <br /> E-MAIL ADDRESS IL DDRESS <br /> 1 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> PARCEL ``'Vogl '� frontage drawn to scale. <br /> El NUMBER o l O- S.J 'GL"�3 1 o $(��) <br /> TOWNSHIP: SECTION: <br /> 1,3 ii r it e /: %1/4: El Driveway permits <br /> ADDRESS: (state,county,town) <br /> yX �l Cankc L■r <br /> ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> -- (public, private) <br /> n't,ile A Am lock let <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> CV G t / Gl2f 41 ,1v- G t� <br /> (L/ r X 2 Z �. Ot1iR strict <br /> . ['This project is a new building or structure. <br /> ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVI E: PERMIT NUMBER: ❑ Rural Address <br /> EWER r)EPTIC (new/exist/NO <br /> HEIGHT IN F T / NUMBER OF STORIES: (Not including basement) <br /> c- / II ❑ Wetland/Floodplain/ <br /> Shore-land (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControi permit <br /> BASEMENT: 1ST FLOOR: (slopes,4, TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: r� <br /> L O Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: �1 ' z `t © � op <br /> and available options. <br /> (Please round to nearest dollar) -�► -.► ♦ -.► ♦ ♦ 11 /U <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes alo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres j o DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? EYes U' o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Efres 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) Efres No ❑Don't know <br /> 7. Is this to correct a violation? Efres to <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ ♦ -. <br /> 545-112(4/08) <br />