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, 0, e ,& 0 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> -CDP-NI1- i-oecie la D Zoning Status; CUP; <br /> OWNER ADDRESS clay tuber,Street,City,State,Zi t • p ►Ac - v213 V yd Deed R IOn; CSM <br /> +-1'i 0 5 u.0 k <br /> 1.,`o C.,/2 i i 5-3 s 2 7 Variance( ) <br /> HOME PHONE CELL PHO E E-MAIL ADDRESS <br /> D Site Plan Firm to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> A NAME CONTRACTOR NAME <br /> 'it u4fL rowed/ -14kwe_11 Pd0C S D Site Plan inciding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS '' �-DtiSo <br /> ' of well/s c <br /> 3Ev3 c.UJAJ RC Q <br /> w,`.537( <br /> (City,State,Zip) (City,State,Zip) D Setb f s <br /> PHONE PHONE D Site PI.1,. •1/roval from <br /> s--7,2-2— / 7 3 0 applica 4 : •' ship. <br /> E-MAILADDRESS E-M ILADDRESS <br /> d i 44,!ve e-4642we.tipuoLss.0 w1 El Floor ploakl�^"'y aie <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevati•• o •,i�•-rty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> EPARCEL O1g/07/1-/of-yc�8q-0 pia. ',SIC, frontag/ • . n to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> CADTriale 6Q o ye- )0 '/4: 51,U '//:A)g 0 Driv rmlts <br /> ADDRESS: (Sta U town) <br /> 4-14) 6 8 ilektecf Rikk 14 D Sanitary rmits <br /> CSM: LOT SUBDIVISION BLOCI~ <br /> 3uGAL� R 64 9 (pu Iv ) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> oq t2DvUh St UCvt4 64 lit)r iDoo C.._ ❑ Zoning t <br /> This project is a(=Pounding or structure. ❑ Permitt$d l se?- <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 0 Rural Address - <br /> [)EWER [EPTIC (new/ex <br /> t, ' <br /> ) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 0 Wetla 1 •plain/ <br /> Shor l* - -chment)` <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and abov- • de decks or porches) <br /> ❑ Ero-�r ■ / . • permit <br /> BASEMENT: 1ST FLOOR: • r ` <br /> ,of 0 j, TOTAL SQUARE FOOTAGE: j (SIO• S, IS urbance, <br /> filling/access) <br /> 2ND FLOOR: RD FLOOR: / /j, <br /> �-1.f6' 0 Revi ocation Survey <br /> ESTIMATED CONSTRUCTION COST: $,../-671 coo.coo and a tillable options. <br /> (Please round to nearest dollar) -► ♦ ♦ ♦ ♦ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes ZNo ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes [Ito gDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes ao <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes No <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 No DDon't know <br /> 7. Is this to correct a violation? DYes ]No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i -i -► <br /> 545-112(4/08) <br />