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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU-TOMER TO PROVIDE <br /> OWNER NAMEE-{}— 1 <br /> RC—" ....0.--1/4A. c 0 ‘1 Ok`C.- LI Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Str t City,State,Zip) �A Q Deed Restriction; CSM <br /> 1 1 S i h'L—� (`\��A�l\OJ` (!\/1s)A `) Variance(# ) <br /> HOME PHONE ELL PHONE E-MA ADDRESS <br /> L•k'5 I LA I poll a. A46) - >fY1(X' 1 * C ] Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Q-- Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ]Setbacks <br /> PHONE PHONE El Si Plan roval from <br /> p'ca e township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> F oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn levation of property PARENT PPRRCELNUMBER: CURRENT ZONIN : ACREAGE: P P Y O <br /> ❑NUMBER O 011 1 - I --(-) - a i (p frontage dra to scale. '1' <br /> TOWNSHIP: E i/ , •1w1 r V <br /> � ft `CSL-aJ'� I 1/4: S� 1/41/: 'v El Drivew permits <br /> ADDRESS:--• <br /> (0-,,,.\ , (stat ,count town) <br /> CSM:'i I I1 S'14 \\4-0-.).3� L �• ��c•u lvl I ico ❑Sani permits <br /> (r ic,private) <br /> PROPOSED PROJECT INFORMATION AFF REVIEW <br /> PROJE T DES IPTI� �` � - 3 5��� O\�. ,Vac �i'1 `p ' _ G <br /> ® ornng District <br /> . <br /> This project is a new buildi or structure. Permitted Use?'. <br /> ❑This project is an additio alteration to an existing building or structure. <br /> itikk <br /> SANITARY SERVICE: PERMIT NUMBER: Lim <br /> IRUraI ' = <br /> EWER EPTIC Nil (newt " <br /> HEIGHT IN FEET:. NUMBER OF STORIE : (Not inclu IA- <br /> 'ng basement) <br /> 4 0.,t It r v S S ❑ Wetland/FI plain/ <br /> Shore/ (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached gar es and above grade decks or porches) ° <br /> BASEMENT: 1ST FLOOR: 1 ç ❑ ErostonContr ermit" <br /> �Q( ,�, TOTAL SQUARE FOOTAGE: 4, (slopes, urbane, <br /> filling/ " ess) <br /> 2ND FLOOR: 3RD FLOOR: <br /> (31-As cj <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -1. --i. ♦ -10. ♦ f 0 and available options. <br /> (Please round to nearest dollar) 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [JNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres ao ['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 <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# I a41't._ ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes uNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ,•1 No <br /> I0 APPLICATION MUST BE SIGNED <br /> 4t,C)C)545-112(4/08) <br /> 0 , (Continue on Back) ♦ —► —► <br />