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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE .7/ <br /> i 1 if l� `� <br /> �� ` � � `��-> Zoning Status; CUP; C Lt <br /> OWNER ADDRESS (Numb- Street,City/State,Zip) <br /> 1%7U\ 54--U\ ,'l l ` ,� y� `��� 1 Deed Restriction; C <br /> �l l )e V \JL���tLXVt, �t� 0 Variance(# C <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 5. z 1. 122 ' 5 1 .' 1. • ■ 1►1■ '1n Cb II' -1 f n ' .fl L [Site Plan drawn to scale ' S_ <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions J <br /> AGENT N AME {�^ CONTRACTOR NAME /0Q <br /> !C,r(A -1-e- �-C i-1 n)Sh i IY� Touch S IC l ��vi�.Site Plan including lo cation) l/`N <br /> AGENT ADDRESS ` CONTRACTOR ADDRE .1 • yyt, _� <br /> 12?) S-12 J e '6 in J.17 Irv('_ 'te •1) <br /> (City,State,Zip) (City,State,Zip) d Setbacks 3��/l �l 0/2(� <br /> Nakl 3-U 1 w i 51.4k401 vv a,u .0 <br /> y t w r ► -1Lc 1 <br /> PHONE PHONE <br /> ite Plan approval from j <br /> "_}1D '551—F)-0500 `A I • J 14GJ.() 0 V applicable township. it <br /> — <br /> E-MAILADDRESS_ � ' E-MAIL ADDRESS <br /> Y t °'' 1 t. . 1+''C1 at r 0.? ` '1•11. CO nr\ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) j24.levation of property <br /> PARENT PARCEL NUMBER: x J� CURRENT ZONING: ACREAGE: P P y <br /> ❑PNAURMCBEELR 1)3 21 CO-)V-1 0 S vCL `� lam— DC ontage drawn to sc <br /> TOWNSHIP: SECTION: �/, / ,( rL �' <br /> a I SC''� -' 1--1 1/4: (/V (v , IA: /t I Driveway permits <br /> ADDRESS: , 1 , (state, county, <br /> CS �-%L O� 1iU O 1 \ n,, �VSUB�IVISI CIA1w11.11(\:)1 LOT55 \3 IV Sanitary permits <br /> 1, 1 3�c 3 .5 w ,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJ CT DESCRI�ION: ■ _ t�f/ if / <br /> U /'� 1 I 3 fl i( 9t� X. 11 Zoning District C Z <br /> . ❑This project il. new building or structure. Q I°i e.J i `� VI) li <br /> (A) 6. l' S Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. s i5 <br /> SANITARY SERVICE: PERMIT NUMBER: Rural <br /> EWER [EPTIC (new i ing) <br /> HEIGHT IN FEET. q/ )?/ NUMBER OF STORIES: (Not including basement) �( <br /> 1 (`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: 1 ErosionCOntrol permit A/ <br /> =v�i� ...4..t.0-r- I 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, /� <br /> 2ND FLOOR: 3RD FLOOR: 1 <br /> �1 <br /> filling/access) ,� / <br /> NI N I v ,Review Location Survey "V <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ r, ��/ and available options. <br /> (Please round to nearest dollar) # <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des (�No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes •No 1UDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Des F2 o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? (Wes ❑No <br /> 5. Is this project associated with a fez. one/CUP/yarianoe(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes C No ❑Don't know <br /> 7. Is this to correct a violation? Efres mho <br /> , . , _ .7' ^-7. <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i <br /> 545-112(4/08) <br />