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- ci:)..)11.41,x4-.-f- <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWNER NAME co"r 1r4'5 �,� <br /> d"Zaning District <br /> OWNER ADDRESS (Number,Street,City,Slat e ip) <br /> �s-t 6. oA i f A� B�,,l£,,� w( s3s�� <br /> �' W. P nnitted Use? <br /> PHONE 6_`�N2�— E-MAIL ADDRESS <br /> C� l ' Zoning Status;CUP; <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Restriction;,CSM <br /> AGENT NAME CONTRACTOR NAME <br /> Variance(# <br /> AGENT ADDRESS CONTRACTOR ADDRESS Site Plan drawn to scale <br /> nd includes dimensions <br /> (City,State,Zip) (City,State,Zip) <br /> Site Plan including location <br /> PHONE PHONE Of well/SeptiC <br /> E-MAIL ADDRESS E-MAIL ADDRESS EMI r Setbacks <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.diane.wi.us/) ite Plan approval from <br /> PARENT PARCEL UMBER: ZONING: ACREAGE: <br /> ❑ PARCEL OLIO 0 65j--1$�(-g5�-a g}) —1 A. applicable township. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> /�OA/TQa31_ g , . SE , , ❑ Rural A•/ /.------- //.- .! <br /> ADDRESS: --- new -xis trig) <br /> '71 51 <br /> G y' R. Pt y L�! wl 535 <br /> CSM: LOT SUBDIVISION BLOCK/LOT Floor plans to scale <br /> 4 levation of property <br /> PROPOSED PROJECT INFORMATION frontage drawn to scale. <br /> PROJECT DESCRIPTION <br /> N Tom.! 3S' Z 6' E ®11s -veway permits' <br /> . This project is a new building or structure. (s te,county,town) <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBE \ r anit• permits <br /> • <br /> ❑SEWER 91EP <br /> fiTIC I V' 1pUbliC,private) <br /> HEIGHT IN FEE : NUMBER OF STdRIES: (Not including basement) Li WetlandlFlOOdplain! <br /> t <br /> Shoretand' (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) .T, , tonCor trot permit <br /> BASEMENT: 1ST FLOOR: <br /> TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR- 3RD FLOOR: 7 0 fllting/aCCess) <br /> '7g0 ,', „ iew Location Survey <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) "r "* "� "+ ♦ "+ �1 and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes ❑No ❑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 ❑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 /> APPLICAS <br /> (Continue on TION BacMUk)T BE-*SIGNED <br /> 545-112(1/08) <br />