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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 /> � L A/1n \Vc tV y Q ❑Zoning District <br /> OWN R 4--ADDRESS (Number,Stre City,State,Zip) . <br /> Q6, 1S4j�--y �-1� �� ❑ Permitted Use? <br /> PHONE ' E-MAIL ADDRESS <br /> ■ l� I� _ S 11 ❑ Zoning Status; CUP; <br /> AGENT INFORMATION I CONTRACTOR INFORMATION Deed Restriction;CSM <br /> AGENT NAME Co TRACTOR NAME Variance(# ) <br /> • >L• i 1 oat !Ail, li <br /> AGENT ADDRESS CONTRACTOR ADDRESS ❑ Site Plan drawn to scale <br /> 113\ 1, ni I 1v si and includes dimensions <br /> (City,State,Zip) ( Ci State,Zip) <br /> el,.V a f 13,1-11 U! ILQ L ❑ Site Plan including location <br /> PHONE PHONE of well/septic <br /> tea— • () CQcn— - Ggga <br /> E-MAIL ADDRESS E-MAIL ADDRESS Li Setbacks <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.whus/) ❑ Site Plan approval from <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: <br /> ❑ PARCEL rr�� t applicable township. <br /> NUMBER , I--1, I--1 \D.-\l.k`-(61,`•N-a. C 1 <br /> TOWNSHIP: SECTION: ❑ Rural Address <br /> T t xuti'1 t LA( \ 1 l 1/4:% t, 1/414: i,3-t-, <br /> d (new/existing) <br /> ADDRESS: • f (� ( �J <br /> �►a i c c c urc,,t! !'SCE cl Jd ❑ Floor plans to scale <br /> CSM: LOT SUBDIt/ISION BLOCK/LOT <br /> ❑ Elevation of property <br /> PROPOSED PROJECT INFORMATION frontage drawn to scale. <br /> PROJECT DESCRIPTION: (� ,.y <br /> Q_4_1'� � S Q1k-\/I()u51 ( ' \1 Q6�1 Ida ❑ Driveway permits <br /> . C3(This project is a new building or structure. Tbi W� f C �+f t. (state,county,town) <br /> L� <br /> ❑This project is an addition/alteration to an existing building or structure ykitokkodA <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Sanitary permits te) <br /> ❑SEWER ❑SEPTIC (public,private) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ❑ 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) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: O <br /> 4, <br /> TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: —to. --to ♦ --o. —o. and available 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 1,SkNo ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes S4No ❑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 ❑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 4No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes -/ No <br /> APPLICATION MUST BE SIGNED <br /> sas„z(1/08) - - (Continue on Back) —► -* -4 <br />