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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME �` / 1. MA Why ,'' I=fs• 7300/04,9//! ' /,r' l, A <br /> L3 ii SZ j/ 9 /011-44/171/ �' 34/7 Lj Zoning Status;CUP; <br /> o NERAqtegDDR S (Num r, t ry, e Zip).,, <br /> y��,�N . Q Deed Restriction;CSM <br /> HOME PHONE b t h f&�EL L PHONE 4y f , /fQZo DDRESS /r.a /'� 5`�54 0 Variance(.__.#.__.___ ) <br /> ttt 6 .23'-3252 4rtutcSZtiF & ' .I/R.iZ tMSite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> O Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) O Setbacks <br /> PHONE PHONE El Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> O Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: El <br /> 0 NUMBER Oa-36 3-Qgob.'9 FP-75 39•f frontage drawn to scale. <br /> TOWNSHIP: . SECTION: <br /> /�(IZmangy f 34'q-4 1/4: SZ 1/a:.Sit/ D Driveway permits <br /> (state,county,town) <br /> ADDRES <br /> 9!v 6 bah lip 4/4014 /ka1.om44ie 5.33'6 ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PRO ECT DESCRIPTION:// <br /> frau /f porch., Lapin Vl,leweL - ( ❑ Zoning District <br /> This project is a new building or structure. <br /> 8 ❑ permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER r}EPTIC (new/existing) <br /> HEIGHT IN FEET: •l NUMBER OF STORIES: (Not including basement) h -2(..it <br /> 42/P 1'DX f�/ 1"��Or�74 tea( / ❑ Wetland/Floodplainl 71t �` <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControi permit <br /> BASEMENT: 1ST FLOOR: <br /> 4 TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> fiiling/access) <br /> 2ND FLOOR: 3RD FLOOR: w,/k .O <br /> 0i� ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -1. -► -i -0. !� ova and available options. <br /> (Please round to nearest dollar) 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Wes [Ito `ii Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Wes o •I on't know <br /> 3. Have you talked with the township about your project and are they in agreement? la es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 1:1 es 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) Oyes j;/ o ODon't know • <br /> 7. Is this to correct a violation? ['Yes IN o <br /> APPLICATION MUST BE SIGNED <br /> (Contlnub on Back) -1 -► -0 <br /> REV(01!9) <br />