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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 /> a-oiAa. Sl1/)J Rip1Zoning Status <br /> OWNER AA DRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 797 `.c747 -1 C�rf PIS/nj, ii..,/ 5-,Y6-2_,- variance(# V-4/ ) <br /> HOMEPHONE 1 CELLPHONE E-MAIL ADDRESS <br /> 1 f <br /> c53 ?O -11''' „ .y , i, e- , -i ' Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION n�1LLd@S.�jR1P �Ot1� <br /> AGENT NAME CONTRACTOR NAME YgftI �r f/' Gll_ <br /> �l r0 A -J i! 14,0-,44 ioilL/7! ass L Site Plan including location <br /> AGEN ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 7'N6' J7 e.14 /2D Sg <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE s f <br /> " '4r/ k,! s-36-4,- PHONE 12 Site Plan approval from <br /> 60F', 5-X?"--de54-* ? applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRE <br /> dd J E A.— Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 'Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ONING: ACRE GE: <br /> NUM ER 2'�'/ kV-0/3-7c)�-7 l � frontage drawn to scale. <br /> TOWNSHIP. SECTION: <br /> ��/ D 1/4: --5— 1/4. tel' Driveway permits <br /> r t n - (state,county,town) <br /> AD RES 0'1 <br /> X 767 tri • a/1 09 Ofiar /49- *3 a i ✓`"s5 z _ Sanitary permits <br /> CSM: LOT SUBDI SION 1 BLOCK/LOT <br /> 0 b fC 04 k (public,private) <br /> drififif <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ❑ Zoning District <br /> IZThis project is a new building or structure. ❑ Permittede? <br /> ElThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural As' -ss <br /> EWER rEPTIC __ _ (new/ 1St no) <br /> 1 HEIGHT IN FEET: ,rit /NUMBER OF STORIES: (Not including basement) <br /> -z/- 3 " -, 1M 1 l 0 / ❑ Wetland/Floodplaini <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) t--k <br /> BASEMENT: I 1ST FLOOR: ErosionControl permit <br /> j TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> /70 -�G' �� filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 7 V3 51'4 T r ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) -ii. ♦ -4. /2,5ea0, Or <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes toQDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Tres a. QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ,Wes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYeslo <br /> 5. Is this project associated with a rezonq V ariance(petition/appeal# 1521 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) lYes ElNo ElDon't know <br /> 7. Is this to correct a violation? ❑Yeslo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4 -+ -4 <br /> 545-112(4/08) <br />