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-r <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> / <br /> PROPERTY OWNER INFORMATION CUrOMER TO PROVIDE <br /> OWNER N E ) <br /> TC Coati dZoni g Status; CUP; <br /> OWNER ADDRESS (Number,Street,City State,Zip) <br /> p ti Deed Restriction; CSM <br /> 76th k t,Qf de ,e ' '- V■ C.t, I V) .L 5...3- 73 riance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> & 27 --S76g ^ash -L az C'e. cow Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Si Plan including location <br /> AGENT ADDRESS CG{Y1e CONTRACTOR ADDRESS S Yn well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE ❑Site Plan appal from <br /> a)iiilicabj,elownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 7or plans to scale <br /> _ <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: tIevation of property <br /> ❑NUM ER *Co 0 8- a 93-9gao -a R tl-a 7,--75, frontage drawn to scale. <br /> TOWNSHIP r SECTION: a ( �Vv r <br /> c�/ vaci-t L 'h: 5 3 1/41/4. 2e ❑Driveway pprthits <br /> state, t✓n <br /> ADDRESS: ( ty,town) <br /> 'r, ers;de Rd ( ao� .3.59"3 // <br /> CSM: 0a-'( LOT SUBDIVISION BLOCK/LOT <br /> ❑Sanita 2rmltS <br /> 1 2 e6- 2_ (p b. ,private) <br /> PROPOSED PROJECT INFORMATION 'TAFF REVIEW <br /> PROJECT E ��jjRIPTION: n <br /> cf'�>',c�► _fp 55 1 hi ,c • oning District <br /> ['This project is a new building or structure. ■ Permitted Use? <br /> his project is an addition/al ration to an existing building or structure. <br /> ANITARY SERVICE: ,-' PERMIT NUMBER: 1 j ❑ Rural ss..}-f_ <br /> EWER REPTIC (new/ xisting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not intludin basement <br /> ( 9 basement) <br /> 2 11 / 0 Wetland/ plain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shod d (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: Q ErOSIOnCon permit <br /> /0g6 'T — 2/�6 ,, TOTAL SQUARE FOOTAGE ,, (slopes, • urbance, <br /> L (J� tin"i ,,est.,) <br /> 2ND FLOOR: 3RD FLOOR: <br /> -" < ,2110 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ -► ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ 70 G <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes alio ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes \lo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No (fit °`4' <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 j o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes �� o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -♦ -► -/. <br /> \fi 3 ? 3 <br />