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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 /> 'R0 -1- 44 T KuL S (JA C 08 S (eU S 7) <br /> ❑Zoning Status; C <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Re rich ; CSM <br /> L/9 3 7 G-6,0DL ,0 Mel( I' D i MM-l)/SOLI// 1/ Variance( ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 63.-x/9- 4)63 1 666- 2/2-yy 0 pc,(JCi cobs C riot : Co ivl elite Plan draw to ale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes di sions <br /> AGENT NAME CONTRACTOR NAME <br /> /v/9 U x/i' t [Site Plan in ud. location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) 12Ketbti,,K <br /> PHONE PHONE ❑Site Plan <br /> applicabl o I <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of rop <br /> © <br /> PARCEL a dra o scale. <br /> NUMBER 0 c e 10-0624970-0 - 3/) .. $6 4 g <br /> TOWNSHIP: SECTION: I0 E <br /> Du A)4/ O I T J 6 N � '/4: N w '/4: ,(,w ❑ Drive <br /> ADDRESS: (state cy town) <br /> 1-/3 9 G-ocp- 0 >c ‹ D <br /> ❑Sav is <br /> CSM: LOT L/ SUBDIVISION BLOCK/LOT <br /> (puf'i• 0 te <br /> PROPOSED PROJECT INFORMATION STAFF R VIEW <br /> PROJECT DESCRIPTION: / i <br /> 3-c, -- 39 y 3 ' DE-Tptc/-/-c=ep G-le Aj-6-- ❑ Zoning Vict <br /> This project is a new building or structure. ❑ PermitttJse? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER EPTIC (new/exyatlf ) <br /> HEIGHT IN FEET: j �� NUMBER OF STORIES: (Not including basement) 1.� <br /> ON` ❑ Wetland F plain/ <br /> Shoreld a hment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ Erosion r` *permit <br /> 40/11- //5-6, j TOTAL SQUARE FOOTAGE: + (slope-/P ance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) <br /> ti / V/ // Slo ❑ Rev' n Survey <br /> ESTIMATED CONSTRUCTION COST: an it I options. <br /> (Please round to nearest dollar) -♦ ♦ ■ '♦ ♦ $ /S U 00, O d <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes I i o ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes [ lo ❑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? 121 .es ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if one) <br /> 6. Is a location survey required? (see reverse) Efres ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -* -+ <br /> 545-112(4/08) <br />