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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> •, NER NAME-- n <br /> -i)-_,i5,--,,,,, rf,'-e 1,.>_q_ <br /> OWNER ADDRESS (Number, e ,City,State,Zip) LOfling Status; CUP; <br /> ��/C/ Deed Restriction; CSM <br /> HOM PHONE �� CE L PHONE E-MAIL DRES` C\J�a �� Variance(# ) <br /> X.5 o//° U S,,, I 102, i' '1,2_` •elk ite-Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> El Site P err-Including ncluding location <br /> "-----\ <br /> AGENT ADDRESS CONT R�DDRESS Of II/s\ <br /> eptIC <br /> (City,State,Zip) (Ci State,Zip) :V t S <br /> PHONE PHONE SIt2 Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> :lF,loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpJ/accessdane.co.dane.wi.us/) n <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ' `! ei vatlon of property <br /> (PPARCEL C t I •4 , frontage drawn to scale. <br /> NUMBER ,;(--.1 i I ,C g---.. / C.j I 7 i <br /> NSHIP: SECTION: <br /> / .1a(,l��J �u ) 1A: T 1/41/4: )Nr�. ❑Drivev�(ay permits <br /> ADDRESS: _ (Stateic nty,town) <br /> 4' 1 Q7 d a /yfa-y j & j C;2{ ia i,d ea 6 3s-i 0 San' permits <br /> CSM: LOT '"J J SUBDIVISION BLOCK/LO)T <br /> (public, rivate) <br /> PROPOSED PROJECT INFORMATION <br /> STAFF REVIEW <br /> PROJECT DESCRIjo•N: <br /> ;G A ' •',_`� i ,! .O!.iP_ J -/4 „ S..,6 .. 0,; Oning District <br /> F►, his project is a new building or structure. <br /> LI Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: / ural Address <br /> ,EWER nEPTIC ` \.,/ (ne .-^°iltii:i; <br /> i HEIGHT IN F • \, 4 NUMBER OF STORIES:t(Not including basement) <br /> P ❑ et d/ odplain/ <br /> A EA TO NEAREST SQUARE FOOT: <br /> e acd (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST OR: r-1 Erosi ontrol permit <br /> / 4, TOTAL SQUARE FOOTAGE: 4, (slopes,di ur fiance, <br /> 2ND FLOO • 3RD FLOOR:/ <br /> -To -,mj filling/acc <br /> `zig ❑ Review L c n Survey <br /> E !MATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ /� �L and"a le options. <br /> (Please round to nearest dollar) / J( ■ , <br /> \' 4, )/; .� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes flo :Don't know <br /> 2. Is there a wetland or floodplain on or near the property? :Yes 1No :Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? :Yes ENo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes <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 :No n't know <br /> 7. Is this to correct a violation? :Yes :No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) —► ■ —► <br />