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ZONING PERMIT APPLICATION www.countyofdane.com <br /> I <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> I <br /> L file Pk ► r ' SC L t t Z f i• 1+1—v ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City.State,Zip) + ) r 7 Deed Restriction; CSM <br /> 7 3 Rr le> aOR t�^I�a 1c Iu:� lt� �3 SW!� Variance(# ) <br /> HOME PHONE 'CELL PHONE I E-MAIL ADDRESS <br /> (W- 31-X675 40S-60-70125 5c Lwnrz ikow+e, 5 ®6'411'"' ` " Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAM <br /> JCS 5C� . r v �IAWLYZ homes roc._ ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTO DRESS of well/septic <br /> 313 iz'It) ,VA N .44, 5-ft- <br /> (city st4 d I C 5-6 Z- (City , Zip) t UT j 35-q o Setbacks <br /> r i 50,1 1�11fi '" <br /> PHONE PHONE ❑Site Plan approval from <br /> W $- 4 6$-� 7 2l ���,�''�-7 ,� `� _ ..._. — applicable township. <br /> E-MAIL ADDRESS i � AIL ADDRESS <br /> Gh�G, r2 Ie c5`�i O' ►'ic 7 /, CO ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> III PARCEL o o 4 01 I%55e v ! <br /> NUMBER _ frontage drawn to scale. <br /> _ <br /> TOWNSHIP — — SECTIO <br /> I1 ` %: 1 '/4'/4: N W ❑ Driveway permits <br /> ,err►�c.�- __- !._.. (state,county,town) <br /> ADDRESS' <br /> _ `a 4 Ct 3 Bi-�,E._ ni Du A..- S --r-r .. . ❑Sanitary permits <br /> CSM. I LOT SUBDIVISION I BLOCK/LOT <br /> 1 LI a 1 1 i (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> /Vat; Ho'w- C 's f rLJc {.IOC^ ❑ Zoning District <br /> . <br /> This 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 /> D 0!7(0 (new/existing) <br /> DEWER ..----�iEPTIC _i-i^1-.ZO11--- ----- ------ ---_------ — <br /> HEIGHT IN FEET: )-5 NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> — - Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT t sT FLOOR — — ❑ ErosionControl permit <br /> 1 21,11 rj�L 1 TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> 2 LO 3RD FLOOR: v fill n9/aGCBSS) <br /> 5 0 ELI <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: Q /� and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ --► ♦ W ��v ► O�� <br /> 4 !11-1 Ili <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres EgiNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres Rio ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Efres Jlo <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 [ No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ ♦ -+ <br /> 545-112(4108) <br />