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ZONING PERMIT APPLICATION www.counityofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OIMI NAME �1�1 ' /� <br /> a 'I- f v&! � Status;CUP; /CT <br /> OWNER ADDRESS (Number,Strwt ity,State,Zip) I / <br /> l 0 ,3 .er Z i eed Restriction;CSM <br /> +✓z� CO C. vrt b(AS . WT 3 0�5 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (00 . 07 S5 .0, bo'.0 70 0 bt..,,e. t t( ' . ii 414;1,(Q"% ' l Site Plan drawn to scaie� A-rill AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensionsC., <br /> AGENT NAME CONTRACTOR NAME /'J'1�� <br /> 13c 4.....% 'fj„ /40„,„,-,A.,,... (1-arse b :16145 `Site Plan including loca on 4T <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/sept <br /> 161' Vs 1-t K r a; ( 5 7 C L,' 1 Dave. <br /> (City,Sete,Zip) (cry,Stste,z+�) ��Setb �Z <br /> �Q/l� �u <br /> (tit..rlt s wT S31a5 Sun p ; <br /> e LIT S 1510 <br /> PHONE PHONE ; ..Site Plan approval from „l/4_ <br /> Go$ Y 3 7 -'f 7 4 S 966 $0 ei i00 applicable township. /'v <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> •f+�my r t,t.v-41 a►y e.raa•l•cow. ya eye bo b S Y @5,v.,..i.to M. Zfrloor plans to scale <br /> PROPERTY+LOCATION INFORMATION (h ttp:Laccessdane.co.dane.wi,us') gElevation PARENT ' - EL NUMBER: CURRENT ZONING: ACREAGE: Of property <br /> ©N1 ER o 9 1 -1 a 1-0 l aQ rootage drawn to scale. <br /> TOWNSHIP: n SECTION: _ <br /> 3)t sto 1 I Ys: Ai t h%: _ 01 Driveway pe ,i.-- <br /> ADDRESS: r� (state,coon , ow. <br /> CSM i i O L 5 k� tr $ anitary.; .iits <br /> SUBDIVISION BLOCK/LOT (pubs <br /> So prtw."1..z (Tree a 1p <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECTP I / f <br /> CF�//11��Ce �/ K ( � Zoning •District A / <br /> ,JThis project is a new building or structure. /Permitted Use? `'S <br /> DThis project is an addition/alteration to an existing building or structure. r ) <br /> SANITARY SERVICE: r//A- PERMIT NUMBER. <br /> �_ Al Rural,A•..•- L,.,Q� <br /> EWER 1 )EPTIC (n- -xisti ,! <br /> HEIGHT IN FEET el NUMBER(W STORIES: (Not including basement To <br /> 1 Alloodplain/ I/ <br /> AREA TO NEAREST SQUARE FOOT: S orate (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: ST FLOOR: SOrosionControl pem�1 <br /> "�~ / Y 3 j TOTAL SQUIRE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 5RD FLOOR: ! filling/access) _ �-ir <br /> ...- ..,, Review Location Survey�7 <br /> ESTIMATED CONSTRUCTION COST: ; ♦ —h. and available options. <br /> (Please round to nearest dollar) $ 1 3 50 0 <br /> r <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes j 10 [Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ►w . DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? OCes I o <br /> 4. Has there been a zoning permit issued for this property In the past 5 years? 126'es ao <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave Wan 'f none) <br /> 6. I.a location survey required? (see reverse) Dyes o ODon't know <br /> 7. Is this to correct a violation? :Yee o <br /> APPLICATION MUST BE SIGNED <br /> 545112(4/06) (Continue on Back) —.1. -11. <br />