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ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME //�� p <br /> C y'Y�A'e� -6Vvr�,5 aYtcQ /�tligt9t1 iC.LuiJnki Zoning Status; CUP; <br /> OWNER DDRESS (Number,Street,ttty,State,Zip) <br /> WW// Deed Restriction; CSM <br /> OME PHONE� 7 Cc`CE/L PHONP1 , Ma E-MAIL vt i ADDRESS <br /> 5-'33 713 Variance(# ) <br /> -6 i 7S-1110 5am.• j ot/le -5a►vt g0 co wtic:l° co 47 n Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION, • and includes dim ensioi5 <br /> AGEIA,NAME 1 CONTRACTOR NAME <br /> C\V--C.\\ S C Ue C 4/14 SO,g- .___ Site Plan including 'ocason <br /> AGENT ADDRESS CONTRTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS —7 E-MAIL ADDRESS <br /> 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wl.usn n Elevation of property <br /> PARENT PARCEL NUMBER: CURRENTZONING: ACREAGE: • <br /> ElPARCEL n ��+ frontage drawn to scale. <br /> NUMBER 070T-3y1`2357-7 ,'^3R /c,PKEzou :, -- LO <br /> . ._.__._..(f IC <br /> TOWNSHIP: SECTION: <br /> /C�w�� 1/: ,/1/4: Driveway permi.s <br /> I 0 �1r�It's°� — (state, county, town) ' <br /> ADDRESS: <br /> 2037 CCCA-Lt A 1(, n Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJEC DESCRIPTION: <br /> Kikt-l-, 0vk i'1 F?(4) (N0 0cf 0 2 ecra e, ❑ Zoning District <br /> . ['This proje is a new building or structure. V j <br /> ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: U Rural Address <br /> EWER {EPTIC (new/existing) <br /> HEIGHT IN FE T. NUMBER OF STORIES, (Not including basement) <br /> I 0 I ❑ 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 /> t So a i/l9 D 4, TOTAL SQUARE FOOTAGE: 4, (slopes, disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> `6 0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -4-► -4 -4 -4. and available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? r L_JI,CF 4j(.d , [ _ li 1 r, <br /> 2. Is there a wetland or flood lain on or near the property? Yes iNo ` )c I: <br /> P p y�. ( � �;� <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? UYes [ [No <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) Dies No Don't know <br /> 7. Is this to correct a violation? JOYes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —4. -+ <br /> 545-112(4/08) <br />