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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Val ' t'e4 6 re"1 D Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> / 8 2. V 'S7' Met 1 3 ' 7 47h 1-)1 S.1S1j• Variance(# DR ANIMAL pNITS <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (w33 69S-22 eS Kt/ )viie.er,e1ie 6ma.•%t�covic� 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> SC.0 74-'y" Seel Vie ii SD S i ai/dwcs- ii 4.C. ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 0g 40 k'> 1,77 se- BP y 4-/m <br /> sf- <br /> (City,State,Zip) (City,State,Zip) D Setbacks <br /> . e ay h 72'`I Wi SSS 8/ S`f© f/b e I ri'i 53527 <br /> PHONE PHONE ❑Site Plan approval from <br /> Cay.- 5/3—Ysi.z 4, 0J--5/3 =-rjb,5/ 2 applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> „5 Ci to `//a i' t7cef-�au e C> ri7 Stew e//6 6' L' /°"= C4D1" 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane-wLus/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> 0 PARCEL <br /> NUMBER o 6/2-z6/-9-2v0- RR-4 4 7 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Me d i ;loc. 2 6 1/4. MC 1/4. 0 Driveway permits <br /> ADDRESS (state, county,town) <br /> Gc.-t-4 Y lejer Rezi. 5150 TOWER LINE RD <br /> CSM: SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> LOT <br /> /`7.6 C / _ (public,private) 3 B R <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> /lien �/v ree Co n 5--, c41C'p/Di/ 0 Zoning District <br /> . SaThis project is a new building or structure. 'Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. �—�/ <br /> SANITARY SERVICE: PERMIT NUMBER: qG Rural Address NEW <br /> EWER 'SEPTIC /3 - 202/- 00 0 77 (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) , ,/ N O <br /> 2 5' % 14' FRONT / �a 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) <br /> BASEMENT: 1ST FLOOR: 2845 ErosionControl permit <br /> /6 8 co /f:'{ 86 + 924—,Y/ 1 TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 7 ;( j <br /> filling/accese C-2021-01 03 <br /> FLO 3RL L�OR: '7 2 3 Deck t);� <br /> J� 1 1 ; ( Qt Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: '÷ ♦ -► .+ ` and available options. NO <br /> (Please round to nearest dollar) <br /> 60 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes , No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes o DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ,�YYes UNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes Fg2No <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) DYes ei o DDon't know <br /> 7. Is this to correct a violation? [Yes 'F2No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —I► —► —► <br /> REV(01/19) <br />