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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME C 0, "4 NL 6 ❑Zoning Status; CUP; <br /> OWN RADORESS (Number, t,City,State,Zip) ��AA�� Deed Restriction; CSM <br /> 9 2 5 0 VP O ava. 'd . t��l.7t IS 1 U.Nk • Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> CQefl G56 31o2- ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 5AAW.- ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL D ( )�^ L3 ..OL U , S frontage drawn to scale. <br /> NUMBER ( J ` <br /> TOWNSHIP: SECTION: /17 <br /> 23 1/,: SIN) %IA: Su' ❑Driveway permits <br /> ADDRESS: c ;� �� (state,county,town) <br /> a <br /> LA 5)4P Pte+W t� ��) ❑Sanitary permits <br /> CSN: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> GM4 E 1 S. tyb ❑ Zoning District <br /> . NThis project is a new building or structure. Li Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER PEPTIC NIk (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ' 2 t l D 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: <br /> I /_ j, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 4' filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ -► —11. -11. ♦ � 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? IRlYes ❑No Iglbon't know <br /> 2. Is there a wetland or floodplain on or near the property? Elves ralo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ( Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es o <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 Jslo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes l■o <br /> APPLICATION MUST BE SIGNED <br /> r A (Continue on Back) —► -♦ <br /> 545-112(4/08) b <br />