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• ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWNER NAME <br /> MAT4 rin1 13. II JSEn1 Zoning District <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Ic'35 CC1)1426(2o0K L-N. STCVC t4Tc'•ti w_r 53S 5 <br /> Permitted Use? <br /> PHONE E-MAIL ADDRESS <br /> c -) F7/— g31 M Hgn1 SFn1 c+>t 1 STt1M. n/G c.cM 'Zoning Status;CUP; <br /> AGENT INFORMATION I CONTRACTOR INFORMATION Deed Restriction;CSM <br /> AGENT NAME CONTRACTOR NAME Variance(# <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> Site Plan drawn to scale <br /> and includes dimensions <br /> (City,State,Zip) (City,State,Zip) <br /> PHONE PHONE Site Pla cluding location <br /> of w septic <br /> E-MAIL ADDRESS E-MAIL ADDRESS ,Setbacks <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ►% Site PI approval from <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: I' ble townshi <br /> ❑ PARCEL eyb/c611-c3Y-53065-2 A � -EX' 2C,''( a PP township. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town) yr PEASANT S P►21rv6 S C 3 1/4: S E 1/41/4: N E ❑ Rural dress <br /> ADDRESS: (ne existing) <br /> 2987C GCE C.KS 0Y Floor plans to scale <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 1'.! Elevation of property <br /> PROPOSED PROJECT INFORMATION rontage drawn to scale. <br /> PROJECT DESCRIPTION: ��77 <br /> AGR�C�1:iV�AC ACCOScnr' ✓+Li)1.�J( <br /> ❑ Drivew permits <br /> . ®This project is a new building or structure. (stat ,county,town) <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Sanita ermits <br /> ❑SEWER CI SEPTIC <br /> (pU C,private) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) CI Wetlan oodplain/ <br /> 2 Sho and (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches 1-0 E • '• CO' rol permit <br /> BASEMENT: 1ST FLOOR: <br /> 52: X 72 + TOTAL SQUARE FOOTAGE: j (slo•- •isturban -, <br /> r_,access) <br /> 2ND FLOOR: 3RD FLOOR: ?7 IN S h T <br /> sCk Review Lo Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -► ♦ ♦ $ 3C C1(C1 and a • le options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ®No Li Don't know <br /> 2. There is 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? ®Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 0 No <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes ❑No ®Don't know <br /> 7. Is this correcting a violation? ❑Yes ®No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i <br /> 545112(1/09) <br />