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f <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App II/ <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAMESe(g_c_.,Y /� `-4� E ❑ Zoning Status; CUP; <br /> OWNERA S (Number,Street,City,State,Zip) <br /> Deed Restriction; CSM <br /> 71dio27 LJ/II t Og- RDA GcliWbSof'i 11'/. .3 9g variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL I ADDRESS <br /> jtos-fig4,-74,34, <br /> -cif .(G IA 41-c s - . 111.-t tf t .ry. ❑ Site Plan drawn to scale vi <br /> AGENT INFORMATION CONTRACTOR INFORMATION and include$dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> IVIAtt Co-rLE2 _ ❑ Site Plan intiuding IocAt�On <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic N v'` <br /> gig O4gi_h u) /ii ❑ Setbacks <br /> (City,State,Zip) (City,State,Zip) <br /> So.AI ?iR/Ri6 iii11 53 <br /> PHONE PHONE ❑ Site Plan approval from <br /> WS -837_U vg7 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale i ' <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wl.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> PARCEL D 910 3o v c2004 <br /> NUMBER 7 _ frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> I(MIPs0 1/4: ,/4,/4: ❑ Driveway permits pi A <br /> ADDRESS: — — (state, county,town) <br /> ❑ Sanitary permits NIA <br /> CSM: LOT I SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION <br /> STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> AIuas6 . l?O cH 1- D.eci4 le-x- ❑ Zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> XThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> Yl SEWER LI SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 17 / _ I ❑ Wetland/F000dplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> T: 1ST FLOOR: ❑ ErosionControl permit <br /> BASEMEN <br /> /V/A 1 Zx14 ?AR cit € 5 x/0'Uri 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> N(A N/� Fe 201 Dc�c:i z <br /> 3 6 Ft 1 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ —0. -► and available options. <br /> (Please round to nearest dollar) $ i 31 C7 'C) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No n Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Iallo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? S.Yes IA N��f//Ey Fl DU/SEb To ��T <br /> � '�l�arvitil� i� 2/x/T <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 4 No $EFake Z eft A/6 e, <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) (54-b6 Pe / <br /> 6. Is a location survey required? (see reverse) ,Yes ❑No *Don't know <br /> 7. Is this to correct a violation? ❑Yes $No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► <br /> 545-112(4/08) <br />