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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNS AME �j� <br /> °�' '- " 'lam e4,-.s ❑Zoning Status;CUP; <br /> OWNER ADDRESS(Number,Street,City,State,Zip) Deed Restriction;CSM <br /> .2-v� .S•o-v4- L. Cov �,� �iJ� k/� S3n7 Variance(# ) <br /> HOME PHONE t�ELL PHONE E-MAIL AD KESS <br /> ^/c,,it- 4,0,-3fa-7/ 7! Srat/ks.4s •.cs•/ • w 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> A f c„�,L o 4I E- ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ['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/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCELMBER 018/e,,/_/y3-gvwo-3 TIER-08/ RM-16 q.1 15 (2.45 TFR ge drawn to scale. <br /> NU <br /> TOWNSHIP: SECTION: <br /> Co+-r L 6e--0 4e._ 1/4: 1h: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> '2_06z0 S-4✓' Z eT El Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 5006 (public,private) <br /> PROPOSED PROJECT INFORMATIONSTAFF REVIEW <br /> PROD T DESCRIPTION: <br /> ENCLOSED STAIRCASEADDt <br /> (/ L • •S.fu;rw� ¢ rdpG/e_L "1"--4;"""g w 141 tcef fZortin tr t TFR-08 <br /> G�VIV✓L t�JCTt/rJ� <br /> . ❑This project is a new building or structurk PYPeirnitted,user""YES <br /> g This project is an addition/alteration to an existing building or structure. lir - ...' <br /> SANITARY SERVICE: PERMIT NUMBER: " Pttt# <br /> Rural s EX <br /> EWER IXTEPTIC (netw/ek ' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) NORTH PORTION <br /> r� etI�/F[ tn' <br /> 2_/ -3 �Sh�an (ate nt)0 PROPERTY <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) '' ,'4' _ <br /> eri <br /> BASEMENT: 1ST FLOOR: onp <br /> Z y TOTAL SQUARE FOOTAGE: 1 (Slopes;diOurtrance1 NO <br /> 2ND FLOOR: 3RD FLOOR: 122 0.0 <br /> !viS.7) 1 <br /> Reriv �i�cattcritinrey N O <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ —, /�UU c� �1nd avail ble options <br /> (Please round to nearest dollar) $ z <br /> NORTH-PORTION <br /> 1. The property is within 300 feet of a stream orQWOEFIC ERTYr lake? ❑Yes ENo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [ 'es ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Wes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 10 <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) Eves ONo ❑Don't know <br /> 7. Is this to correct a violation? [fres I►� o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -+ —► <br /> REV(01/191 <br /> $62.20 <br />