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ZONING PERMIT APPLICATION www.countyofdane.com . <br /> SUPPLEMENT to Web-App I <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> �� <br /> � <br /> /6.6-W.>t' 0 Zoning Status:CUP; <br /> Street <br /> OWNER ADDRESS(Number. .City.State.Zip) <br /> 7 ��` ` �� Deed Restriction,CSM <br /> HOME PPoNE / / /2 LADg5E v iO4 '")t S'S 7/g. Variance(# ) <br /> CELL PHONE E-MAIL ADD ESS <br /> s7f-3, '6 --er".s-,•�=3iG' ,e tf/`;€ -c f ee!)x, , #, ❑Site Plan drawn to scale <br /> ,AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> --..4,/,‘)7x-: 1Z -eT ly�,���` <br /> 1 E- '' s ixt= ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3 /J-y .1 f� I I) <br /> (City,mate.gyp, <br /> (City State,Zip) ❑Setbacks <br /> t-Gij 1 Q4.'.✓ Ji S3i/r <br /> PHONE PHONE)g- -5-7.1- <br /> _ ❑Site Plan approval from <br /> _a 7,1- �4 applicable township. <br /> E-MAIL ADDRESS / <br /> E-MAILa S �! <br /> � (� P�/E. id - i l„; ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/Jaccessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING. ACREAGE: 0 Elevation of property <br /> 0 <br /> PARCELNUMBER <br /> :. /0 I Z315/9k F 12_y S` frontage drawn to scale. <br /> TOWNSHIP ) n SEC IONS <br /> ADORES'-- _()11/rrt/) ----- '7". '�.. <br /> — ❑Driveway permits <br /> (state,county,town) <br /> •x,34,3 eTeiZs0A/ i2) D i/A so Zvi .s,r. <br /> CSM I LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION' <br /> 4,71.5_1./ <br /> //C%7j( /V1:::-(.1 z-G)),>(/''...5/,-""f) ❑Zoning District <br /> • This project is a new building or structure <br /> L) Permitted Use'? <br /> ❑This project is an addition/alteration to an existing building or structure <br /> 'SANITARYSERVICE. PERMIT NUMBER .. - ❑ Rural Address <br /> l rs::ER 54EPTIC (new/existing) <br /> HEIGHT it FEET _.-....__._, <br /> Z 2. / NUMBER OFSiiiR,E� lwotm,iUd,�goasen,Ent <br /> ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> I(Outside dimensions including unfinished area,attached garages and above grade docks or porches) <br /> i BASEMENT. �/ IST a p^� i-. <br /> ErosionControl permit <br /> ✓mo b , ,,TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> 2ND FLC•')9 Y�'c'J` S~ <br /> C 3RDFLOOR� I filling/access) <br /> 1 <br /> ‘<,/�3_ ❑ Review Location Survey <br /> ESTuvir TED CONSTRUCTION COST. <br /> (Please‘r•.r ..,,nearest dour) -10 -' '� -I. -+ S �`�- and available options. <br /> 1 T s;rty is within 300 feet of a stream or 1000 feet from a pond or lake? ' Yes 4tdo ❑Don't know <br /> .r 2 wetland or floodplain on or near the property? ❑Yeso ['Don't know <br /> avg.,ou talked with the township about your project and are they in agreement'? Oces o <br /> t'r<,,hare;ten a zoning permit issued for this property in the past 5 years? ❑Yes , (o <br /> •s in,..,,project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> - Is a location survey required? (see reverse) ❑Yes ' No ❑Don't know <br /> 7 Is this to correct a violation? ❑Yes J:.\..'o <br /> APPLICATION MUST BE SIGNED <br /> TEv;orn;; (Continue on Back) -+ -► <br />