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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME p <br /> 5 1 1 t\Ro(Q C Lu i"(1 ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) j, t- o g2.S Deed Restriction; CSM <br /> SOO R KM\ � Q A\LLz`( RokLi w.i_ r, 3 57-Z Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> g , S L( 76-1 J3 L■ CC PAS N , C G f‘(-) gi ::Man drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION: and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ptit Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS PVG 1 ell/septiicc� <br /> (City,State,Zip) (City,State,Zip) V ❑Set�M>`•►„ <br /> " <br /> PHONE PHONE DAN colfill VI Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS 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 /> © <br /> NUMBER 0 SO 6-3t1-Y110 A„ (c )C f SO frontage drawn to scale. <br /> f <br /> TOWNSHIP: SECTION: <br /> P ^- 1 . 31 %: i J I : s w El Driveway permits <br /> (state, county,town)ADDRESS: <br /> IN-NCO N T tic,t2,2p <br /> a 5L, � fin\(Y\2 t.1 1 ALL-� i , ort. VJ .J <br /> 5��?.2 ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION 34 STAFF REVIEW <br /> PROJECT DESCRIPTION: ,��`* T <br /> D �y st ❑fr d ing DDtst1ct,-7 <br /> . ❑This project is a new building or structure. <br /> ❑ ermitted.Uses,` <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ RUral Address <br /> EWER 1EPTIC (new/existing) ' <br /> HEIGHT IN FEET: 3 ( NUMBER OF STORIIS: (Not inclu i g base ent) <br /> ❑ Wetland/Floodptain/ <br /> Slioreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) t <br /> BASEMENT: 1ST FLOOR: ❑ �rompCOntrot permit _-If <br /> 7 7 O 4, TOTAL SQUARE FOOTAGE: ,; (slopes dstragce }r <br /> 2ND FLOOR: 3RD FLOOR: J �"fiII g CCeSS *-t ,,', c. A <br /> 730 <br /> ® R6ilie Location- rveY,:. <br /> ESTIMATED CONSTRUCTION COST: 1� LI OO u and available options. ' <br /> (Please round to nearest dollar) I "l <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Ego ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? DYes lai" ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Dyes to <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Eres ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank i one) <br /> 6. Is a location survey required? (see reverse) [Yes No 26on't know <br /> 7. Is this to correct a violation? Lives <br /> APPLICATST BE SIGNED <br /> (Continue on ION BacMUk) -* ♦ -► <br /> 545-112(4/08) <br />