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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> IINC,�O,S k-A 'e..7 oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City, ,Zip) <br /> £ ' I i,?'%Ce �� w! Deed Restriction; CSM <br /> Gam' Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS Q� <br /> 3 - g3o N s�� <br /> Ite PlartSdrawn to scale ) , ao <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> /et ra/. '" ` a- h AAjyPn✓5 Ite Plan including location <br /> AGENT ADDRESS CON TOR ADDRESS of well/septic <br /> f. W #44 Sr 5/ <br /> (CA,State,Zip) (City,State,Zip) etbacks <br /> PHONE PHONE ❑Site ap oval from <br /> 0425.-P357/ applic b ownship. <br /> E-MAIL/ADDRESS E-MAIL ADDRESS <br /> ('.:, ('',11, ,•-,,",,• ;,,•O Of loor ans to scale <br /> PROPERTY/LOCATION INFORMATION (httpJ/accessdane.co.dane.wl.us/) ation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> ❑PARCEL /� l frontage drawn to scale. <br /> NUMBER 06)O )�p C f cO`? 0 1�Y-/-e-1 1�I <br /> TOWN HIP: SE�TION: <br /> v h,y� I . 1/4: s f '/1/a: ❑ Drive : p- its <br /> ADDRESS: (state, nty,town) <br /> ' �'S L e. ❑SanitaN •ermits <br /> CSM: L� SUBDIVISION BLOCK/LOT <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: \ <br /> Gaut G.1 d n S FA d� .� oning District <br /> . ❑This project is a new building or structure. rmitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMB A ral Address <br /> EWER 1 EPTIC 'V (new/e�N rrtg <br /> HEIGHT IN FEET: �� v NUMBER OF TORIES: (Not including basement) <br /> )� S ❑ Wetlan. F •:•plain/ <br /> AREA TO NEAREST SQUARE FOOT: S -n. (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FL o : , J ❑ Erosio C rol permit / <br /> (� �/ 4, TOTAL SQUARE FOOTAGE: + (SIO , 'sturbance,IV <br /> 2ND FLOOR: 3RD FLOOR: fl I g/acce s) <br /> yReview Location Survey <br /> ESTI ATED CONSTRUCTION COST: � J and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ '♦ -► -�► $ ) 00/� <br /> rif <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes Rio ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? , ]Yes No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ales ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes c410 <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) Efres No ❑Don't know <br /> 7. Is this to correct a violation? Efres No <br /> APPLICATION MUST BE SIGNED <br /> f (Continue on Back) —► -+ <br /> 1 545-112(4/06) <br /> I <br />