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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER MME ,� <br /> re 1p c � igt. 7°'""• t/e/)? 'rekn h� g Zoning Status; CUP; A —/�( <br /> OWNER ADD SS (Number,Street,City,State,Zip) / eed Restriction; CSM <br /> 7303 eir � R.i Loci, Lot ,s.4- ' <br /> Variance(# ) <br /> HOME PHONE CEL HONE E-MAIL ADDRESS ,^ <br /> 444 -.'l,3' 1 Site Plan drawn to scale (.� <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions Amp <br /> AGENT NAME CONTRACTOR NAME p <br /> %all Ze.4 / d/ ..•y bai/%,6+� Site PI_ ing location <br /> AGENT ADDRESS CONTRACT��O��jjA RE� • ,- I/sept'� /3 <br /> Maas. 0..mor PoNe. /9D laced, ` 3 d <br /> (City,/State,Zip) (City, tate,Zip) ,�1 Setbacks <br /> /7/4..,, c.)Z ,6-45z z (City, <br /> Lot ,Si59.0 <br /> PHONE PHONE Site Plan approval from ,(/if <br /> ,G art-7.7 AP RS ea--,r5:-tor 9'7U0 applicable township. �" <br /> E-MAILADDRESS® E-MAIL ADDRESS <br /> c zee*/ f ' yke.aim 400•1 d taco �e <br /> /ao•y •Ille.S'tOiw /4 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn ,� <br /> #(1 <br /> PARENT PARCEL t�I,UMBER: CURRENT ZONING: ACREAGE: 6 Elevation of property <br /> ❑PNAURMCBEELR © ` o K-10 -g0©O k4 — / r--t, 'ID rontage drawn to scale. <br /> TOWNSHIP: SE T N: <br /> '�,J , , N Driveway permits <br /> Tow�t ♦l�ollt. /a: 5 /4/4: (state, county <br /> ADDRESS: Uv <br /> '3a3 i;11 ivy /& Lod/, L`7r 633.Ss' Sanitary .- . its <br /> CSM: LOT SUBDIVISION BLOCK/LOT (publAra <br /> PROPOSED PROJECT INFORMATION STAFF REVIE <br /> PROJECT DESCRIPTION: 5/0/.5.e./4/7 / r <br /> .S' /3S x/7' /7o.-Ame r j 4,•so. Zoning District <br /> . rgThis project is a new building or structure. Permitted Use? fit Q CA •�'-<-- <br /> ❑This project is an addition/alteration to an existing building or structure. 5'Lc�/ <br /> SANITARY SERVICE: PERMIT NUMBER: ARura-.• h'& <br /> ETEWER r)EPTIC /5/ (ne existing <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ,7$',"' / X�- - -- loodplain/ <br /> •horel-.• (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) �- <br /> YErosionControl permit <br /> BASEMENT: 1ST FLOOR: /0 <br /> /a 90 4, TOTAL SQUARE FOOTAGE: ,l (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> — 7029 <br /> Review Location Survey Ay, <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ �/ and available options. ` <br /> (Please round to nearest dollar) $ / Ob° <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes [✓]o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes 621No ❑Don't know <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? Efres 2 o <br /> 5. Is this project associated with rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) [Yes Ito ❑Don't know <br /> 7. Is this to correct a violation? [Yes EKo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />