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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDES <br /> OWNER NAME I �, /j[ ^- ' <br /> �oe I Sa ar Zoning Status;CUP; {�`�3 9 '2_ <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> D-11) Frisco (our± Variance(# ) <br /> HOME PHONE 'CELL PHONE E-MAIL ADDRESS <br /> 1,).01-1/5' S'i3/, J c ,J- Ll c.r k� f" I °SOY`' Site Plan drawn to scat 3 <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimension <br /> AGENT NAME CONTRACTOR NAME <br /> L,s-00, Cbhs--rt,,,-i,g.-. ■13, I,terl arc Gus 60ns;-1J'v- I l�'( A Site Plan including locatiory <br /> AGENT ADDRESS CONTRACTOR ADDRESS / n of well/septic y� <br /> g"09 6;ctrL oa ROI' D OC 1 ( rcLWccf..l Pats f . 3/ 0// v�✓U <br /> (City,State,Zip) _ (City,State,Zip) Setbacks lfC/ <br /> Cross PIC,;,,s, UJ;; S 3S)x' C rocs pia;rs W;S s'35-�8 Zs <br /> PHONE PHONE 1,�: Site Plan approval from <br /> 6 O _7 7 g y3 ys ,O.g - 790 - 4(3 9..S .pplicable township. /�- <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Sl-YhZ.Oh 1jCj,crirs•het- &sy-,,.,Lb✓►S 0Jo.rUs ° net Floor plans to scale <br /> X �'PROPERTY/LOCATION INFORMATION (http../accessdane co.dane wi.ust) �Elevationofproperty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: frontage drawn to scale.DPARCEL O$Og's3E1-9791-0 Re5,G(0^3ic.) 1.3y <br /> NUMBER <br /> TOWNSHIP: ` SECTION: t Driveway permi <br /> S t r""5 $ ;e IJ 3S /.: S E �.A: NE (state,county own <br /> ADDRESS: Rd( ■ cAlei0� <br /> 6 ree.h b r ict r 1{ M J ( W;� <br /> 4 Sanitary a-rmits <br /> CS'O S-W LOT SUBDIVISION BLOCK/LOT (public, ;y ia► <br /> PROPOSED PROJECT INFORMATION STAFF REVIE)V <br /> PROJECT DESCRIPTION: `I I //` -1 <br /> Ne„/ aSTor i-es ; iow,c Zoning District <br /> 235' 7-- <br /> . ®This project is a new building or structure. Permitted Use? Sc <br /> OThis project is an addition/alteration to an existing building or structure. 1 , \ <br /> SANITARY SERVICE: PERMIT NUMBER: Address �C T(G <br /> EWER nEPTIC <br /> 13- a.o l y-oo ti a---7 -xisting) 0 pea_ <br /> HEIGHT IN FEET: ° NUMBER OF STORIES: (Not including basement) wetlarld/FIOOdplaln/ vi F-1- <br /> 3 i 6�� a Shoreland (attachment) e, r <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> )permit q- <br /> BASEMENT: 1ST FLOOR: <br /> 073 e'f Z J- e[ TOTAL SQUARE FOOTAGE: 1 Slopes,disturbance, / 0 <br /> filling/access) / -f / <br /> 2ND FLOOR: 3RD FLOOR: <br /> y a� o cj . 2 /„ AiReview Location Survey n <br /> ESTIMATED CONSTRUCTION COST: $ Cr 5O O Q�O. O�() and available options. A/A- <br /> (Please round to nearest dollar) 9 V V <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes Eli'10 DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes o DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? BYes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? uj�',es ow <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) Dyes No DDon't know <br /> 7. Is this to correct a violation? Dyes ®No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) _ = _ <br /> 545-112(4/08) <br />