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. ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER ADDRESS • Kt,`` ' 0 Zoning <br /> SS (Number, te, g tld9;GUF'; <br /> 0 3 3 i=T 5 O 5,4k/if es-I-4- t j estnction;CSM <br /> HOME PHONE CELL PHONE • ariance(# ) <br /> E-MAIL ADDRESS <br /> *' -Pa-35130 Si Plan drawn to scale <br /> AGENT INFORMATION � CONTRACTOR INFORMATION d includes dimensions <br /> AWIT NAME C RACTOR E s4 ct. <br /> AGENT ADDRESS G k J ep" n ' ' —A` ` ( 0 Sit Ian including location <br /> G r CONTRACTOR ADDRESS (' O ell/septic <br /> A i y(9'l 4J e Sot 4 f�1 Q ik o�•, a v) ,S >I"�-e. ik 's (r 6. ,�$ <br /> (City,State,Zip) (City,State,ZIp) Setbacks <br /> PHONE PHONE ❑ Sit Plan approval from <br /> 60E- Fi plitte tohip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS _,/ <br /> L] Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PAR EL NUMBEE n/ N4jJQ3•' 'teACRGE: ❑ Elevation of property <br /> ❑ PARCEL ^ U `[f r 1 /NUMBER 7 �, , y 3 frontage drawn to scale. <br /> TOWNSHIP: r SEC N: - / <br /> I� V NA 1'U I '/: '/.'A: N C ❑ Driveway permits <br /> ADDRESS: ° (state,county,town) <br /> 7- 3 3 VIN (._ ,,4 . Rae , <br /> CSM: �4 LOT I SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: Po/ti o v .t-e 4 .0i tteANieD Skvo -a dk6fu ❑ Zoning District <br /> This project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/ Iteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> "SEWER EPTIC __._ (new/existing) <br /> HEIGHT IN FF ET: / 4/ t NUMBER OF STORIES: (Not including basement) <br /> FP �,// <br /> / CI 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 1 ST FLO R: ❑ ErosionControl permit <br /> / 0 TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: 01 YU 0 filling/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ �� m ( and available options. <br /> (Please round to nearest dollar) rte) OP <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? es No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? L�1Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank• none) <br /> 6. Is a location survey required? (see reverse) fes No ❑Don't know <br /> 7. Is this to correct a violation? DYes 44o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► —► ..80 <br />