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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
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<br /> PROPERTY NAME OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> �� c1 '6r � D scl �- A -/17=4
<br /> L Iw `L�J.17 - 7-'v'S 7- Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM
<br /> SE "/ , 110,y 73 1174,25Hrdi t!}/ 5 3$5') Variance(# )
<br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS 4,(---O -8�3 71 `5 K1 1.4 Site Plan drawn to scale
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimension 01 „ /I
<br /> AGENT NAME CONTRACTOR NAME
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<br /> iq t, ii) ,4. :ye--EL 00.4:71►5 ALIii 1.)j",‘„-- Li C. ,.Site Plan including locati
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> (City,State,Zip) (City,State,Zip) Setbacks (: S3/4,5AA
<br /> m66RS#n'1e_ L0/ 5.7'S-5' PC%y/41 'mac: IV r 5-3ç 55
<br /> PHONE PHONE' Site Plan approval from 4/
<br /> 6 g�/3.9/,2S (�,0�f-- �' 9 J --77 / 'Z applicable township. �,�}-
<br /> E-MAIL ADDRESS E-MAIL ADDRESS ' I
<br /> 50/e7 C C 6:11-/A;[cc ( ' nmY,;Cvr3! 0 Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) /Xf‘
<br /> PARENT PARCEL NUMBER: CURRENTZONING - ACREAGE: a Elevation of property
<br /> D NUM {%
<br /> BER v g12- 1 5 3 (05N-tom' - / 4----K /90 54,la rontage drawn to seal!
<br /> TOWNSHIP: //�),,,, SECTION: 1
<br /> ///�//1i,4 /S %<:5!i '/4%: ,' I 9,•'v .y permits
<br /> ADDRESS / - Stage,county,town)
<br /> 5k f /�' .•- -7- fail :cI!, t( L,k_ii, 51i--,-5
<br /> [Sanitary
<br /> CSM: LOT SUBDIVISION BLOCK/LOT 7—(publi rivate) _
<br /> PROPOSED PROJECT INFORMATION STAFF REVIEW
<br /> PROJECT DESCRIPTIO : ��
<br /> ,6 C- '/C('l.7-4 '121-
<br /> L '121 R r !JL '/1 2 4j'C•--- *oning District A / ,
<br /> This project is a new building or structure. 3 ( r� Z y ')C 1�� Permitted Use? G} `1 E
<br /> DThis project is an addition/alteration to an existing building or structure. / 4 SANITARY SERVICE: PERMIT NUMBER: Rural $., 4 1 - I
<br /> EWER EPTIC (new xi sting)
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) /
<br /> /& j Wetland/Floodplain/ !v 4_
<br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment)
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)
<br /> BASEMENT 1ST FLOOR: , ,Elopes, ontrol permit A, /
<br /> k C/ 1 TOTAL SQUARE FOOTAGE: 1 (slopes,disturbance, /
<br /> 2ND FLOOR: 3RD FLOOR: filling/access) //
<br /> 2 L
<br /> Review Location Survey ,f
<br /> ESTIMATED CONSTRUCTION COST: >n and available options. Q
<br /> (Please round to nearest dollar) --► i —, $/ `/ ��)G) /
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes 'lo DDon't know
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<br /> 2. Is there a wetland or floodplain on or near the property? Yes ao DDon't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? DYes DI'o
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Wes DNo
<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) Dyes R Jo DDon't know
<br /> 7. Is this to correct a violation? DYes Nlo
<br /> APPLICATION MUST BE SIGNED
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