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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME y II '' <br /> it G) 5,2, 0o/16 .Tvv- ❑Zoning Status; CUP; <br /> OWNER RESS (Number,Street,City, tate,Zip) ` Deed Restriction; CSM <br /> i O. rcd)L (V Coay t G2�� t(') ` 53''Zl Variance(# ) <br /> HOME PHONE CELL PHONE' "AAILADDRESS <br /> '� <br /> t 06-21 c.."-S% C6,1110, a '�e,p_L. /446. tom ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME C TRACTOR NAME ,� f I <br /> u�� c, I 1 `J ...v. tic/hes TJL ❑Site Plan including location <br /> AGENT ADDRESSNTRA TOR ADDRESS of well/septic <br /> V D.PUS El Setbacks <br /> Co ii <br /> c,9 <br /> State,Zip) (City, e.Zip) <br /> c,9e &dog('Gvr 5 21 <br /> PHONE PHONE / ❑Site Plan approval from <br /> 603_2Jcj - Si.03 applicable township. <br /> E-MAIL ADDRESS MAIL ADDRESS <br /> , If AZ,S 4iU�7 lr <br /> ncw,w) La,' ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpJ/accesadane.eo.dane.wl.usl) 1=I Elevation of property <br /> PARENT PARCEL NUMBER: CU ENT ZONING: ACREAGE: <br /> ❑PARCEL a7ll gip/ -2244-d ke5 SFR-08 4.69 frontage drawn to scale. <br /> TOW SHI / S TI N:1 } <br /> /� hcM( l9/eJJ2 IN 1/4: /l1 E 1/4: lO ❑ Driveway permits <br /> ADDRESS: (state,county, town) <br /> 2214 WOODED RIDGE TRL <br /> CSM: LOT SUBDIVISION ' , BLOCK/LOT III Sanitary permits <br /> / (public, private) 4 BR <br /> I S <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 4 BEDROOM SFR ❑ Zoning District <br /> . This project is a new building or structure.hi <br /> U Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address NEW <br /> EWER PEPTIC l 3-ZGz1-pOz 34 (new/existing) <br /> HEIGHT IN FEV: NUMBER OF STORIES: (Not including basement) NO <br /> 27 q v( 2 ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT. 1ST FLOOR: ❑ ErosionControl permit <br /> 1 60� '1 (1 S Z + TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, NO <br /> lJ L/`l filling/access) <br /> 2ND FLOOR. 3RD FLOOR. <br /> (0-7(0 L-1'-) 0.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: r <br /> (Please round to nearest dollar) '♦ ♦ '� 'I. ♦ $ '?(� Geo¢ and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies [ 10 ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? :fres go ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? EYes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [fres EINo <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) ❑Yeso ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> $523.00 APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> REV(01119) <br />