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ZONING PERMIT APPLICATION www.countyofdane.com 1 SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNEF NAME <br /> —�J V .+ .� ( l� ❑.Zing Status; CUP; <br /> OWN D'D7RES Art er,Street,City,State,ZP Deed Restriction; CSM <br /> A`� / Art (- J it' 'F�2, g_)066.nfh.T.3b/(c--A-Eg Variance(# ) <br /> H.• E PHONE dar ONE E-MAIL ADDRESS <br /> 'V ^�� Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE PHONE Idle Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> (Kr plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT CURRENT ZONING: ACREAGE: EI atlon of property <br /> ❑NUMBER a 5(I —07 —p1^( O 7ECTION �_ rontage drawn to scale. <br /> TOWNSHIP: : <br /> uxi k i Y` 5 1/4: }J t,(j 1/41h: Ai '®2fiveway permits /j 4 <br /> ADDRESS: (state county,town) r <br /> CSM: (5 7 LOT ' I(da nnS nitary permits y/4 <br /> SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ��,, ��, <br /> 671 L 7 y S a0 \L�'Zoning District <br /> This project is a new building or structure. h�'Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: aRt al Ac ss <br /> EWER TIC (new/ fisting <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) , ,r. <br /> I ( 'Wetland/Floodplain/ //V/'`./) <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ,D-ErosionCOntrol permit <br /> BASEMENT: 1ST FLOOR: <br /> 1- (0 j TOTAL SQUARE FOOTAGE: + (slopes, disturbance, , <br /> vV filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 63 ' - view Location Survey A /"') <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ v,O and available options. /"� <br /> (Please round to nearest dollar) $ X900. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 4lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres IgNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Z es ['No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? r es ❑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 gNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 0 N <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ -* <br /> 545-112(4/08) <br /> I <br />