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ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNERME <br /> OYV)h o,2teS ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Nu r,Street,City,State, ) '_ / Deed Restriction;CSM <br /> 673.37 G WA lig Variance(# ) <br /> HOM P CELLPHONE E-MAIL ADDRESS <br /> K,t-K:, vVg8' -4 ®/GPS u ♦citify.f• 0c . O/; 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> __ 0 Site Plan including location <br /> AGENT_ _ADDRESS ---- <br /> -- CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Z p) ❑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/) <br /> PARENT PARCEL NUMBER. . �j/CURRENT ZONING. ACREAGE., El Elevation of property <br /> ❑NUMBER o '/[J -c23( ` 0- r.,,, ._ HC <br /> G� frontage drawn to scale. <br /> TOWNSHIP: SEC IC.. / <br /> .1/4.. ,/: -PC ❑Driveway permits <br /> ADDR s9: P_ , (state,county,town) <br /> 337 �� n k% ` 71 ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJEC,DESCRIP ION: .41 COMMERCIAL STORAGE BUILDING <br /> -eirte _. t2 —._....._.._..._......_..._ VZoning District <br /> . This project is a new buil id ng or structure.9, <br /> Perrrtitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: c1Rural Address <br /> [ EWER PEPTIC (new/existing) <br /> HEIGHT IN FEET: Nt.IMBFR OF STORIES: (Not including basement) DC PZP-2020-0099 <br /> it Wetland/Floodplain/ <br /> -1 Shoreland (attachmentl <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> /ErosionCantrolperrri6 <br /> BASEMENT: 1ST FLOOR V" <br /> O� ,, TOTAL SQUARE FOOTAGE: ,, (slopes,disttlrtvnct;, <br /> r filling/acc' <br /> 2ND FLOOR: 3RD FLOOR: 4073 0.0 S E20210192 <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ �,s�l� and available options. ye <br /> (Please round to nearest dollar) S(,/U Q,�F A 7 A HAN S <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake?YES ®Yes ? . ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes W.- o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ►1 es ENo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Q es ❑No <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) NEO,..P.ER.A.Z.A-..HAN.S Yes ❑No ['Don't know <br /> 7. Is this to correct a violation? ❑Yes VNo <br /> • APPLICATION MUST BE SIGNED <br /> (Continue on Back) —. -► •♦ <br /> REV(01/19) • <br />