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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME II II // j <br /> `�tirej/l>Se_ ttiv(,r IGlns (Pôf\ Gb I ri I L,f-64,1 ❑Zoning Status; P; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed R tri on;CSM <br /> HOME PHONE <br /> C 1:1 v�CELL PHONE , ri tAI RESS 5 1 7 Variance ) <br /> O; -3o/-' ['Site Plan drawit9..salr <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME 1 CONTRACTOR NAME <br /> at`o v. ia sc,ns T J K bet t--,t ❑Site Plan ini udgocation <br /> AGENT ADDR jSS CONTRACTOR ADDREW of wellseptid/ <br /> qoo ti la r ( 2 c.)J- t1 - <br /> (City,State,Zip) (City,Stile,Zip) ❑Setbacks <br /> � r«fi LJI 5-35 3 2 Y--r ok. 01 s`X06/ <br /> PHONE PHONE / / ❑Site Pla a �v <br /> 6,0$" - 2)R-6)q 0 — 2s-7—/0R'O appli ii� P. <br /> E-MAIIIL-- DRESS E-MAI •'DRESS ff (� <br /> Ka .e.a,S 140 Ly+'►5�'l. 40�-L '� . - set-�k��('lao t Jl,cau ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dano.wi.usn ❑Elevati0 of party <br /> PARENT PARCEL NUMBER: CURRENT ZONI G: ACREAGE: <br /> ❑=8E1 ©gp?—f ?-Ql3 6-O A -2(g) /0, i frontage wn to scale. <br /> TOWNSHIP: SECTION: <br /> Q�� /C ''/.: Sc,W %%: SE El Drive � <br /> `� - (state, o t�lf,'fbw i) <br /> ADDRESSO /`t Z 59r1 Ucjir./ Llk <br /> CSM: r LOT SUBDIVISION BLOCKILOT Sanitary permits�( ( � <br /> r p�S ; (public,private)a ti' t It— <br /> PROPOSED PROJECT INFORMATION I 1 ' <br /> PROJE(T� CRIPTION: t <br /> ∎1-t rat 44 ''``'\ h,,.tic_ ❑ Zoning DiVill <br /> . ❑This project is a new building or stnJdure. <br /> ❑ Permitted U <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Ad a " <br /> EWER P4EPTIC (new/- / t-'�- <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 2:3 0 Wetland/FloodplaiN <br /> ,t Shoreland (attachment) <br /> y <br /> `:, AREA TO NEAREST SQUARE FOOT: <br /> r 1: (Out.sjdlimensien,kincluding unfinished area,attached garages and above grade decks or porches) ❑ E��iOnCOMr01 permit <br /> �` ENT 1ST FLOOR: 7 <br /> I,c2-4? + TOTAL SQUARE FOOTAGE: + (Slopes,disturbance, <br /> ' filling/access) <br /> \'. FLOOR: 3RD FLOOR: <br /> 1 r 2' ` :`) i ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ _ and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ $ /CO 000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes El fo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes Rio ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes [lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ao <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 ao ['Don't know <br /> 7. Is this to correct a violation? ['Yes IVo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4108) (� 2 (Continue on Back) -► -► <br />