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c1 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> / s <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNERME <br /> CILLe.\0 4- Ca,,rz 1.7t ' ' El Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip), ,,� <br /> 201Lt 4-14 i o1 �)ecti C.)r.vc_ r�•.P L.fi x Ski u,r. y35--Z Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE 1 CELL PHONE E-MAIL ADDRESS <br /> 40V37 D Ali 61 toc4- Z7 -co 7,3 C b'(W( `t C' '-i ' 0'm Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> �4 Wb <br /> 3e.ck Cm s c4t (3,0)r k) <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> '36 Ccwdilul LA <br /> (City,State,Zip) (City,State,Zip) [Setbacks <br /> 5au14 Cl i UJ,t ,5-ss13 <br /> PHONE PHONE r dSite Plan approval from <br /> 60g• 370- °rzz'( applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> bt,ckcor.,t g .04«:(• tort IOOr 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 /> ['PARCEL //�� iQ�( '7 f frontage drawn to scale. <br /> NUMBER 01 <br /> 0-1 I DJ 1001 l- Qe,S:de,LP,1 1 1.17 <br /> TOWNSHIP SECTION 14-SL g-j J✓ <br /> 12c)rb ' %IA: riveway permits <br /> wr �4. (state,county,town) <br /> ADDRESSS: <br /> la 11 B1 it a-Lit(4\A f.e G`5 1'Ryhikel4 LA. Sanitary .- <br /> CSM: LOT SUBDIVISION BLOCK/LOT . <br /> ( 7 ✓ (public private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION. . <br /> CR <br /> Li 1 d r1/0 S � u' +�y 1104,e i hac� ct, +�12/t ❑ Zoning District <br /> . ]This project is a new bui <br /> or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE. PERMIT NUMBER 0*+3_ i5- r7 o ❑ Rural Address <br /> EWER EPTIC 13 - 7o il-oliZ7L (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> a i ❑ Wetland/Floodplain/ <br /> AREA10 NEAREST SQUARE FOOT: Shoreland, (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1 ST FLOOR: ❑ EroslonControl permit <br /> TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> MI �� filling/access) <br /> 2ND FLOOR: 3RD FLOOR: rij1714 .S.—.5O <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: $ and available options. <br /> --I.(Please round to nearest dollar) - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Wes a o ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Elves j 4ei ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? es No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes IIVU <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) [Ces I';; 'o ['Don't know <br /> 7. Is this to correct a violation? ['Yes C 'io <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />