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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> • <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER/AME <br /> 4 /7- O Zoning Status;CUP; <br /> OWNER Ari,RES (Num reet,Gity, te,Zip) .5'37/7 Deed Restriction; CSM <br /> ,0 Variance(# ) <br /> OME PHONE �YCQELLP�O�� <br /> E-MAIL ADDRESS �� <br /> �' ��(( 7 ❑Site Plan drawn-to scale b <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME ^/6k-ire rri <br /> ❑Site Plpnetading location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well ptic <br /> • 3t 6, 1564m_ Sii-- 7161 �LI'a71t- _ — <br /> (City,State,Zip) (City,State,Zip) Il Setbacks • <br /> AiA-d/v,4 11".2-e____ -S3S1-7 <br /> PHONE PHONE III Site PI a'fb • at from <br /> =NCO..-.c<(s'Cs applic bl: 1.wn hip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS O.U`44) <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn.� ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: / <br /> ElPARCEL Ql©4'—So /_G /l�i Pi; ia� A_ frontage drawn to scale. V <br /> NUMBER 6 ^� <br /> TOWNSHIP: SECTI N: <br /> 1/4: '/a'/.: • ❑Driveway permits /� <br /> ADDRESS: (state,county,town) ry <br /> w Dr aP-5 a <br /> CSM: LO SU•:VISION N24 BLOCK/LOT ❑Sanitary permits <br /> j (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> A/, J- f7 ❑ Zoning District <br /> is project is a new building or structure. ❑ Permitted Use? A/ <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> PTIC <br /> EWER E 1 '— D-0 14 — OOl,3 'existing) <br /> HEIGHT IN EET NUMBER OF STORIES: (Not including basement) <br /> r _ ❑'Wetland/Floodpl in/ <br /> . Shoreland (att e tt <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> - ❑ EfOSI0nC0 O�It <br /> BASEMENT: / 1ST FLOOR: <br /> I N' 5 a 0/ 4, TOTAL SQUARE FOOTAGE: ,, (slopes,di u' a ce, <br /> filling/access) <br /> 2ND FLOOR: �I2/� 3RD FLOOR: _ <br /> 7 J_ \ 4'a(Ai" 'S �� ❑ Review n urvey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ COO/ <br /> / and ava able options. <br /> (Please round to nearest dollar) 0�i Uv V , <br /> • <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Oyes Elo ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes. o ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? f j'r o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Efres [L]IQF <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) ❑Yes pG o ['Don't know <br /> 7. Is this to correct aviolation? / OYes C '0 <br /> / / / APPLICATION MUST BE SIGNED <br /> 545-112(8/09) <br /> (Continue on Back) —o. —► —► <br />