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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER'.INFORMATION .. _ CUSTOMER TO PROVIDE <br /> O) R NAME <br /> /moo 6/j JG f-/N�L--,( E-'C�Ek._ <br /> Zoning Status; CUP;OWNER ADDRESS (Number,Street,City,State,Zip) <br /> ,Q O��D�'7 `2V/5.'Y� Deed Restriction; CS <br /> �� 5/ N0 ��/�� " ` � -r Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (2(5 k—£'_b--- 5t o , /L G 5'C'///-,z 01/zfr11y.✓, /l/e/04 Site Plan drawn to scale <br /> AGENT INFORMATION . . CONTRACTOR INFORMATION and includes dimensions <br /> ANT NAMES/� /� ,per CONTRACTOR NAME <br /> /�,i6�i1C� .�.61e%t/�Z LEE /-/6/14er.5 6147/;1/4.5 Ji:,V17i ❑ Site Pl.•- di g location <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> of w,.. /septic <br /> /e J i J��J /� s / D � 7` �: /Q I <br /> (City,State,Zip) (City,State,Zip) A Setbacks S o ' / <br /> ✓ <br /> � <br /> D/f o.✓ ai./ .S3S75 <br /> PHONE PH N��j p _ XSite Plan approval from <br /> 6 ok ��c�6 0 v �jiJd --4/3s-rn ipc�s7S -seyo applicable township. <br /> E-MAIL ADDRESS <br /> E-MAIL A RESS E-MAIL ADDRESS <br /> 5G ff Ne�" jJC�r iZo�l o/t/e j ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn • ❑ Elevation of property <br /> PARENT PARCEL NUMBER: �CURRENTZONING: ACREAGE: P P y <br /> Li NUMBER oi-3z3 -3o$ -5 x-1�< z, y/3 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> /./A/� !JW/y' 1/4: -5 w7y 1/,/: Li Driveway permits <br /> ADDR ss: (state, county,town) <br /> 1 6 2 2_ 544/4 #/LG 4/3 <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BIK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: 'J f r <br /> ,S i/ _ /) S f r 1- ° ❑ Zoning District <br /> 1-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: Li Rural Address <br /> ❑SEWER SEPTIC (new/existing) <br /> HEIGHT IN FEET: / 2, (\\\ 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 1ST FLOOR: / n <br /> / Li ErosionControl permit <br /> { �/ // 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> ill... L/ 8 <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -► -► ♦ ♦ ♦ ♦ r and available options. <br /> (Please round to nearest dollar) `: ��` <br /> 1. The property is within 300 feet of a stream or 1000 -et from a pond or lake?�J t ❑Yes No CI 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 ZNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? CI Yes tNo <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 ❑No Li Don't know <br /> 7. Is this to correct a violation? ❑Yes ,KNo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -0. <br />