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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PI3OVIDE <br /> ER NAME <br /> 0,106 41A/ NaKCIA\ JII` Zonir �.:t CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ❑ <br /> De:. R stn tion; CSM <br /> ( - P S SV t S C.0i kfi tf wt SS-12— Variance(# ) <br /> HOME PHONE ELL PHONE E-MAIL ADDRESS <br /> ■ W ❑Site Pla dr.wn to scale rve ; <br /> AGENT INFORMATION CONTRACTOR INFORMATION and incli, -s dimensions <br /> AGENT NAME CONTRACTOR NAME t. n et.L., <br /> P(thit r WA Svtu`i S ❑Site Plan' ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/se Ic <br /> 17A4 &W\ 1/A11,1 Pci <br /> (City,State,Zip) (City,State,Zip) El Set (S <br /> 141-= tbi tr7 VVl 5S`. 17— i` <br /> PHONE PHONE ❑Site Plan approval from Sit <br /> ( ' iukQ SZ1D° applicable township. V <br /> E-MAIL ADDRESS E-MAIL` ADDRESS <br /> 6b0. !l bj1 • co a nSblL ❑ Floor pia4to4le <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi-usn <br /> PARENT PARCEL NUMBER: OP CJ O!CURRENT ZONTIG: ACREAGE: ❑ Elevatl Of o�rt <br /> 0 PARCEL NUMBER _3 Z 1 Pc 1 frontag r- <br /> � � <br /> TOWNSHIP: _n SECTION: <br /> "o -' ( 1 Sp'trc3ot ML- S 2 Y.: WC %Y.: S t/ ❑ Drivew��, - • s <br /> (state r'`'"'° y, own) <br /> ADDRESS: <br /> (Si-2- .P S SA �S C `iS ^ ❑Sani e �,C //e--Woci--; <br /> : SUBDIv ON BLOCK/LOT ub <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: (r�Q • <br /> �Oix�.e.. ��Q. -Nyh i l L-I U Zoni stncf <br /> . %This project is a new building or structure. Q Permitt��+ <br /> " <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/e <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 13 o Wetlan I a ant <br /> Shoreln merit) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) '' <br /> Li Erosion • t olpermit <br /> BASEMENT: 1ST FLOOR: TOTAL SQUARE FOOTAGE: 4, (slop '•t •once, <br /> 2ND FLOOR: 3RD FLOOR: flling • S) <br /> S 1l0 <br /> © Review o ton rvey <br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ♦ ♦ ♦ ♦ QQ and 71.1t,ora options ,(Please round to nearest dollar) $ 2,6t.CC�D <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes V4fNo 11Don't know <br /> ❑ <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'? 'f Yes LiNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ' Yes ❑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) ❑Yes alNo ['Don't know <br /> 7. Is this to correct a violation? ['Yes 1 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ -4. <br /> 545-112(4/08) <br />