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ZONING PERMIT APPLICATION www.countyofdane.com FE:= <br /> PROPERTY OWNER INFORMATION Cu OMER TO PROVIDE <br /> OWNER NAME i <br /> Kelli & O ad 0a1 U,, ing Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip1 <br /> D ed Restriction; CSM <br /> VOID )(-0..mo stree- O('e a l-E S35-76— V riance(# ) <br /> HOME PHONE CELL PHONE E-M DDRESS <br /> -5h;- _ 'I- ■ b ,, L_,•% -.Da9 ell(Aniu-,,-, .a_hto• ci'l- ❑ . Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NA E fiore l ite -7:4414, (Crals1 Site Plan including location <br /> AGENT ADDRESS CONTRACT�bRR- DDRESS �Jl of well/septic <br /> "/55.D Vero'ta O 4 <br /> (City,State,Zip) (Ci State Zip) Setbacks <br /> ff./1460o, Wx 537/1 <br /> PHONE PHONE ❑ Site Plan royal from <br /> (3i ) ø '—;?-00 pplica township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> PARENT PARC NUMBER: CURRENT ZONING: ACREAGE: P P y <br /> ❑PARCEL 06,- p5iti'--/i6 � `� �_i frontage drawn to scale. <br /> NUMBER oy,--,c�2 t$ • <br /> TOWNSHIP: SECT O ,� ) <br /> R,.{-t�n d �� 1/4: N 1/41/4: S \I\J ❑ Driveway pe is <br /> ADDRESS: (state, c nty,town) <br /> 7D1/4 Truonaan Street p cer\ W L S3S?5 ❑ Sanitary its <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> publi rivate) <br /> (D N,..--Sec�5o45 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ( )( OZ e _[ Zoning District <br /> . gThis project is a new building or structure. '_I Permitted Use? <br /> This project is an addition/ eration to an existing building or structu e. <br /> SANITARY SERVICE: PERMIT NUMBER: J Rural A i dres <br /> FIEWER EPTIC , (new/e sting <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> I Wetland/Flo plain/ <br /> Shorelan attachment) • . <br /> AREA TO NEAREST SQUARE FOOT: �r <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ErosionCo I permit <br /> TOTAL SQUARE FOOTAGE: 1 (slope , isturbance, <br /> 2ND FLOOR: 3RD FLOOR:vvv ^ /r fill /access) <br /> �` JIT �J _ D Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: —o• ♦ -� $ and available options. <br /> (Please round to nearest dollar) / ....51(y) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes ®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'? Yes LiNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? nYes ONo <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) Dyes ENo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) *----0 CD 1 -3 . <br />