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ZONING PERMIT APPLICATION www.countyofdane.com F32211:2313:222C1
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<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OINNER NAME
<br /> n Zoning Status;CUP:
<br /> OWNER ADDRESS (Nunmer.Street City,State,Zip) Deed Restriction;CSM
<br /> t_331 a_ IA ALv EP-so" F o s-r-ou91-6,k, S-35-(O cl Variance(#__ )
<br /> H.T'rvIEPHONE .CELL PHONE 1—
<br /> i F.--tvIA4 AN:AI:SS —
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<br /> 1G°S 73-301) 4-s 4AAE I Pcirc', Pr°`.1 (e (99 VIA Cki I. ("A rl Site Plan drawn to scale
<br /> 'AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> A'aENT NAME I CONTRACTOR NAME
<br /> .-1=12-AN 40 ?ARIL,I n Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> Vi-t k\At...\)EV-St r- P-4
<br /> (City.State,Zip) (City State Zo) 0 Setbacks
<br /> S- 6-35-col
<br /> -4
<br /> PI IONE PHONE D Site Plan approval from
<br /> * applicable township.
<br /> ® vv.)4).,,,,v\i,t1),,, 0 Floor plans to scale
<br /> ,PROPERTY/LOCATION INFORMATION (http://aacessdane.co.danie.wi.us/)
<br /> PARENT PARCEL NUMBER CURRENT ZONING
<br /> ACREAGE 0 Elevation of property
<br /> , n PARCEL ,o1.=',,io(olo--z-4,-1_1501,3t1 411/4-I (6.x) q 0 frontage drawn to scale.
<br /> TOWNSHIP i SECTION-
<br /> DUAW I -2."I- '4. SE i,<11,4: SE 0 Driveway permits
<br /> ----- (state, county,town)
<br /> ADDRESS:
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<br /> D Sanitary permits
<br /> 'CAM: 1 LOT 1 T,1 JBDivI,sr,rj t3L OCKILO i
<br /> ! (public,private)
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<br /> .111.0008E.D PROJECT INFORMATION ._ . ,. - ... . .. .`•_: ' : . . . STAFF REVIEW
<br /> i pRo,Ec,L'ESCRIP FION:
<br /> G re r A 40,-,,i•€. / tiot,i0 Haus a: Li Zoning District
<br /> . This project is a new building or structure. D Permitted Use?
<br /> OThis project is an addition/alteration to an existing budcing or structure.
<br /> SANITARY SERVICE
<br /> T.-PERMIT NLIM,3ER. U Rural Address
<br /> DEWER FIE?TIC I
<br /> cE-INJFD (new/existing)
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<br /> HGHT IN FEET: INUMBEF:OF STORIFIE.40, .4-Iihs,n,1r
<br /> I I Li WetlandiFloodplain/
<br /> H -- - Shoreland (attachment)
<br /> AREA TO NEAREST SQUARE. FOOT: A
<br /> (Outside dimensions inc.Iuding unfinisned area. attached garages and aboill,-Odeldtaksroi porches)
<br /> ,-- U L-I ErosionControl permit
<br /> EASEMENT: 1 1ST FI OOR'
<br /> fslooes disturbance
<br /> ; ,r)FAt SQUARE,noTA0E-. i .:.,. :: - -,
<br /> 3 a A-4-0 x 13 H
<br /> 1- : ..
<br /> .,-,-...-4 fining/access)
<br /> 2N1,FLOOR. I 3RD FLOOR krnigt.0
<br /> I ......-- ()Mitt epikwi
<br /> 1 D Review Location Survey
<br /> - "
<br /> ESTIMATED CONSTRUCTION COST: and available options.
<br /> (Please round to nearest dollar) 1
<br /> 1 The property is within 300 feet of a stream or '1000 feet from a pond or lake? ... ....... Dies No ODon't know
<br /> 2. Is there a wetland or floodplain on or near the property? DYes ETNo ODon't know
<br /> 3. Have you talked with the township about your project and are they in agreement? 'Ofes ON°
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years'? ElYes No
<br /> 5. Is this project associated with a rezone/CUP/vaiiance (petition/appGal# ______) (leave blank if none)
<br /> 0. Is a location survey required? (see reverse). DYes a o DDon't know
<br /> 7. Is this to correct a violation? Dies a.
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —■ —■ —■
<br /> 545-112 4/0£0
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