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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME , � C ' <br /> Zoning Status; CUP; <br /> OWNER ADDRESS (Numb ,Street,City tate,Zip) Deed Restriction; CSM <br /> 3?J7 - , . • bf'. , )()(`' 5579 <br /> Variance(# ) <br /> HOME PHONE eiga PHONE ®I E-MAIL ADDRESS <br /> 6.49- `t� ;?3 , 66f— 77f r. &A , %r' • dSite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT�AME �® n1 CONTRACTOR NAME t <br /> SQL K of V t tom{/�^tlke-fi ["Site Plan including location <br /> AGENT ADDRESS w �� CONTRACTOR ADDRESS of well/septic <br /> le ).S 11) 0 e <br /> (City,State,Zip) (City,State,Zip) EKetbacks /,---- <br /> PHONE PHONE ❑Site Plan appr la from <br /> applicable wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (h ttp://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRE ZONING: ACREAGE: vation of property <br /> El PARCEL NUMBER oo a/os12_ 6 i 3y5gi -3 ,f8 frontage drawn to scale. <br /> TOWNSHIP: / , SECTIO <br /> 4IIL1 i 36 1/: NE +/4o/: h'W 11Kriveway permits N A_ <br /> ADDRESS (state,county,town) <br /> � riAc.. f <br /> CSM: ��� LOT �� ►�■� �+r ��• S.. �ry permits IA.ntf <br /> /aLl '� *,SUBDI ISION BLOCK/ f <br /> ., j / (public,private)FASO - <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: r <br /> S 1 /10dc oning District <br /> , This project is a new building or strut ure. 'ermined Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ral A s a -s <br /> MEWER E}EPTIC new/-xisting <br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not including basement) <br /> lb • dAie— W tland/Floodplain/ <br /> oreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: n <br /> (Outside dimensions including unfinished ed area,attached garages and above grade decks or porches) ALN„ � <br /> BASEMENT: 1ST FLOOR: 9 ErosionControl permit <br /> 9 'a-f- f� ,�Ogg , TOTAL SQUARE FOOTAGE: ,, (sl es,disturbance, ,t ! 1�� <br /> w fi ng/access) L! T <br /> 2ND FLOOR: 3RD FLOOR: g ) 3' g Q 1%' .isivi <br /> I <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -i ♦ ♦ ♦ dlQ/ �� pQ and available options. � <br /> (Please round to nearest dollar) d IA e oil, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es Dlo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? es o �on't know <br /> 3. Have you talked with the township about your project and are they in agreement'? �'es Lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes to <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) Ekes n o ['Don't know <br /> 7. Is this to correct a violation? `�� QYes rs o <br /> z.\O <br /> 22--S APPLICATION MUST BE SIGNED <br /> drykat,01) (Continue on Back) -► -.545-112(4/08) <br /> ( 6.4pf,..‹...........„ <br />