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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAM �` n <br /> ..111 \- jrv1 v ( ��� r\ \( c) ' (/ <br /> - Zoning Status; CUP; f� �. <br /> OWNER ADDRESS (Numb Street,City State,Zip) Deed Restriction; CSM g {' <br /> I%' `� �rlX1�l ( � ut1�CUt, �i ) ) cf) 4 k \ Variance(# n1C-; ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 5• Z • L12.ci 11` - : ' 1. 11\1 #.11\ '( l Cb O (71ln 0 ' .n l- <br /> Site Plan drawn to scale / <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions 9 —'i l <br /> AGENT'NAME ^ CONTRACTOR NAME S 2 <br /> �U Q - rs i-t n l Sh l ( Tbu Ch J ICI(1 Site Plan including locatio (_�/� <br /> AGENT ADDRESS c,_ CONTRACTOR ADDRE$ J o well/septic <br /> —17-9) S I u \l e ..D - 2?, J.17 t�+ I-\iC' kC .1) �-�( <br /> (City,State,Zip) (City,State,Zip) u Setbacks 30* if 0/i <br /> �vUC1UO-u I vv 5 yO o vv a,u a u , W 1 IBC 1, ce 30 <br /> PHONE PHONE '�/� :1 Site Plan approval from <br /> -1 I� c iSl�C`D-0500 -1 15 L`r J 1)F3 0 0 applicable township. OA. <br /> E- AIL ADDRESS _ E-MAIL ADDRESS <br /> I(c� a" 1 t ti• - '')r1 d r c'? \ S r I A. CO rin dFIoor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi.usl) evation of grope <br /> PARENT ^^PAARCEL'N]UMMBBER: /� CURRENT ZONING: ACREAGE. <br /> ❑NUMBER 1:J,L'( 1V-1- ) - isF� " lam— v( nC' frontage drawn to scale <br /> TOWNSHIP: SECTION; <br /> MOC11 SC .t- 1/: ,/,/4. �� Driveway perm <br /> state, count ,town <br /> ADDRESS: ` {�V� <br /> LL\ .-2L4OI--1 1N t&t \ �"V\) N�CA,•115171 1 t 1i: 'E551\ ) Sanitary permits <br /> CSM: LOT SUB (VISION BLOCK/LOT <br /> 61 3u 3 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJ �SCRI�Ii N: ! ] 1 ,� 'I(��( n •2-/ / /0 /``Z et k .72 / /A Zoning District 9 L ')j <br /> . ❑This project i new building or structure. D' y!f3 c-- 9l/5-�Fh' r^#`(T 2 r <br /> Permitted Use? y! d <br /> This project is an addition/alteration to an existing building or structure. I/UGC <br /> SANITARY SERVICE: PERMIT NUMBER: �( RuralA•• - s <br /> EWER FIEPTIC �/JQ ne � (E•,)HEIGHT IN F r /1 NUMBER OF STORIES: (Not including basement) /� <br /> 3 I Wetland/Floodplain/ N// <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) �� <br /> AI ErosionControl permit A/ <br /> BASEMENT: 1ST FLOOR: �f �( <br /> NI/i� t�,pt--' ©O 4 TOTAL SQUARE FOOTAGE: 4 slopes,disturbance, <br /> �`JLI filling/access) <br /> 2ND FLOOR: 3RD FLOOR: (1� <br /> rx N I Ut ,`' l' Review Location Survey,,L nrelrif- <br /> ESTIMATED CONSTRUCTION COST: . and available options. <br /> (Please round to nearest dollar) -0. -0. -0. "r -0. -0. $ -Ce UU <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes LONo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Des •No Upon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes 0 o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ( Yes No <br /> 5. Is this project associated with arezone/CUP/varian e (petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Dies CNo (]Don't know <br /> 7. Is this to correct a violation? ❑Yes ao <br /> APPLICATION MUST BE SIGNED <br /> r i (Continue on Back) ♦ -i <br /> 545-112(4/08) r. ._., ., ...__,...,-...1 <br />