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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Ada r n - A- m r\.- Po p-e, Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 13:0 g W I LA-D w ID r1 V� Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE (90 Y' CELL PHONE 620 g E-MAIL ADDRESS <br /> —1C1——1°I b3 29 S - 1 X13 to a� i O p� ��'� 'vr, � t ° to Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME C RACTO/7NA / <br /> o�»e...c, ,ri 1 ' <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> i (a3S---icw, -ri..,)-4 r <br /> (City,State,Zip) (Ci to Z Setbacks <br /> L� 63 7f( <br /> PHONE PHONE Site Plan <br /> approval from <br /> (72-7q — X73 <br /> applicable township. <br /> E-MAIL E-MAIL ADDRESS E-MAIL ADDRESS IR <br /> r 0r4.,ecr Gm . Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y <br /> 0 PARCEL i m /�/�(� / L,J frontage drawn to scale. <br /> NUMBER ol1--V '1 — LOO-- I / / /D N I11 <br /> TOWNSHIP: SECTION: 1'� <br /> (�11 '2 1 Iq4. S ,/a,/a. Driveway permits <br /> ADDRESSI � Orl /-S"�d �Na. (state, county, ) <br /> 3 p `� state, count ,town <br /> I J 6'0 w L L.C> V r'- e,p ,/� �-,, T S 3 'S 3 L "Er <br /> Sanitary LOT SUBDIVI OSI N BLOCK/LOT LEI Sanitary permits <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> tr{yj,A.r 1 F x,'s nc fn n L.L.1 . ❑ Zoning District <br /> ErThis project is a new building or structure. ❑ Permitted Use? <br /> El This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> OPTIC EPTIC i3_2 % S— 0002.4' (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> i CI I ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> ❑ ErosionControl permit <br /> J <br /> 2y O �/ ,.. _ i 9 I 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> S ■ S—1 .3 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) 3S <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ayes to EDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes allo Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes JNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ayes laic) <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) ayes So JDon't know <br /> 7. Is this to correct a violation? ayes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ ■ —► <br /> 545-112(4/08) <br />