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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 /> 3-70 i \i` ©S F 0 ❑Zonin atus; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed striction; CS <br /> /(6l KC 1K I l el, f'�j�Dttczmo o , 5-7c, a Variance # <br /> HOME 'HONE U CELL'HONE E-MAIL ADDRESS <br /> 603g. `0 oo 603q s--s-ozo PFW'P* a5 tJ _ 6 u Al ❑ Site Plan dr to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> S A t(\ ❑Site Plan i luding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s tic <br /> (City,State,Zip) (City,State,Zip) ❑ Sets <br /> PHONE PHONE E Site Plarl, roval from <br /> applicabl wnship. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ❑ Floor plansscale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of pro erty <br /> PARENT PARCEL NUMBER: /y CURRENT ZONING: ACREAGE: <br /> ❑PNUMBER 03��V/7O8-'1753-8��p' 1 1'L/ > -r 6 i ,),-00 frontage driyin to scale. <br /> TOWNHIP: SECTION: <br /> MOO 0(...e TO(\1 SEc s-7-8 f/4: Liy'' ❑ Drivewa is <br /> 1/4' S (state,cdur7 t wn) <br /> ADDRESS: <br /> q 641 ROC lel k eck. IM., to tDcztt3 w t _53 S 6 2 ❑ Sani p its <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (pu ic, v e) <br /> PROPOSED PROJECT INFORMATION STAFF,EVIEW <br /> PROJECT DESCRIPTION: <br /> 4 _ C 2 6AQ jetCoE 2 X fit; ❑ Zoning strict <br /> • This project is a new building or structure. CIPermitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural +sttrl"s <br /> EWER IC (new/ g) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> I C ft-Er ❑ Wetld; l,Aid.lain/ <br /> AREA TO NEAREST SQUARE FOOT: Shor land (-ttachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ Erosio Co }tr permit <br /> c/� / �!' S �� 1 TOTAL SQUARE FOOTAGE: j (slope 7 nce, <br /> 1 "` (� V v filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 0.0 til <br /> ❑ Revie at' rvey <br /> ESTIMATED CONSTRUCTION COST: and av bltions. <br /> (Please round to nearest dollar) --i. ♦ -I). --iii. -10. $ -a(J �,v <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes NNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes iNo EDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Elves ONo <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) Eyes FANo ❑Don't know <br /> 7. Is this to correct a violation? Dies ii2No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ -► -► <br /> REV(01/19) <br />