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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> ° NAME CUSTOMER TO PROVIDE <br /> A it'AL-‘ ---)0/-e 0 -e 1.)o,-1 I/AO-9/1 <br /> OWNER ADDRESS(Number,Street,City,State,Zip) ❑ Zoning Status;CU <br /> l J7 G' -Q-o<-. 0 bqf' Ai t /D/ , b��� Deed Re • ' ;CSM <br /> w 5-35"Z V Ce(# ) <br /> HOME PHONE CELL PHONE <br /> E-MAJLADDRESS <br /> 0s a ? ❑ Site Plan drawn to scale <br /> AGENT INFORMATION i CONTRACTOR INFORMATION <br /> A�NAME ( COTOR "E and includes dimensions <br /> �(J I''1 N C h 0-e/0/6 IA) -IA // C O,^�'t i irc^1 `o"s ❑ Site Plan including <br /> AG ADDRESS g location <br /> (C/7 �/ ��c� I CONTRACTOR ADDRESS /� of well/septic <br /> State,Tip) J_ (f A k s-6 S i71 `F' /a J P't G-,•t-+ <br /> FIO ! (City,State,Zip) 0 Setbacks <br /> I� w <br /> P 1 5-?5 -S----- <br /> PHONE ❑ Site Plan approval from <br /> 6 o -2/ p <br /> E LADDRESS <br /> E-MAIL ADDRESS <br /> applicable township. <br /> a 9 • ' 44 CO, 0 i 46/.4011 ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:llaccessdane.co.dane.wi.us/) <br /> ❑ <br /> PARENT PARCEL NUMBER: 0 C RENTZONI ACREAGE: ❑ Elevation of property <br /> NUMBER b `5 f O '6?-D Y�- -/ s 1? F .5S frontage drawn to scale. <br /> TO HIP: /0 8 S 6 . <br /> � � n G ^ � SECTION: a <br /> /3 /? i/ a y4: s Y4%: - Driveway permits <br /> ADDRV:91 (state,county,town) <br /> 1 £Ire-e I6 -he ikdAre <br /> LOT SU j VI ION BLOCKJLOT ❑ Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT SCRIPS]° f /� STAFF REVIEW <br /> /v4 � / 41-e -J rf o✓1-t P �-J/ (� ,q�14 P !A,✓0 /�°c1 ❑ Zoning District <br /> • ""This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. ❑ Permitted Use? <br /> cture. <br /> SANITARY SERVICE: , PERMIT NUMBF( ❑ Rural Address <br /> *EWER EPnc 5- // /% 3 2: <br /> (new/existing) <br /> HEIGHT IN FE:.,....../ ( NUMBER OF STORIES: (Not including basement) <br /> a ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)ca?BASEMEN ���� F Q ❑ ErosionControl permit <br /> 7(J 1 j TOTAL SQUARE FOOTAGE , (slopes,disturbance, <br /> 2ND FLOOR;... 3RD FLOOR: ��O 2 filling/access) <br /> ESTIMATED CONSTRUCTION COST 1:3 Review Location Survey <br /> (Please round to nearest dollar) "► -► '� -► -► -► $ ve'(6'3 CL� and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? le Yes ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes oon't know <br /> 3. Have you talked with the township about your project and are they in agreement? cYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Y 6 .No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (I ve blank if none) <br /> 6. Is a location survey required? (see reverse) Yes ❑Noon't know <br /> 7. Is this to correct a violation? - ❑YesNo <br /> APPLICATION MUST BE SIGNED <br /> s4s-»2 once) (Continue on Back) -► -► -� <br />