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'-fn r 6 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PRONTO <br /> OWNER <br /> Zoning S -tus; r P; — / <br /> OWNER AD ESS (Number,Street City,State,Zip) Deed Re .rich•n; CSM <br /> ZZY L,.�$ �-�le 51u it' G``�% �� J � 3 Variance _ )' y <br />, HOME PHONE i CELL(PHONE E-MAIL ADDR S �,, <br /> ' (/.15-3 i 3-C`13`/ file_ 11u /161,.."1,eon 2 Site Plan drawn to <br /> AGENT INFORMATION CONTRACTOR INFORMATION a • •es dimensions <br /> AGENT IA E /� CONTRACTOR NAME <br /> a l l K gir I 051 Scat o e/J 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 72 2 /.sky Lel e 1`61 I. I„) ll«-u- ) 1 a/ - 7_5 4A-7 <br /> (City.State,Zip) (City,State.Zip) /1 Setbacks <br /> 5 / �,..1 , �y ,s---3s-{53 �d.� u r s--3 s5-3�" <br /> PHONE '7 PHONE ❑ Site PI../ a 4'v. om <br /> Cwb-35'3-6 YAy (w$ – Z1 L-1 Z/1 applic.;,I, .hip. <br /> E-MAIL ADDRESS E-MAII ADDRESS <br /> A ilj)M 11 ecyr1 -c1; 4,41 A ,com Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Eltif property <br /> PARENT PARCEL NUMBER: CURRENT AI NING: ACREAGE: evaon o P P y <br /> 0PARCEL 0.701_1Z3-6,1Z1 .— frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECT` E`/� <br /> i21 0X (` +/,. +/,+/a: sr_ , Driveway permi r <br /> ADDRESS: (state, county, . • <br /> / kaik)L ,60...4\ <br /> ❑Sani ary rmits <br /> CSM: LOT SUB SON BLOCK/LOT <br /> ,�_, 2_1 p,�Sc i I_ 1 k' l:cief (publ , private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIE <br /> PROD' • 1"iN: / <br /> - Zoning District L/ <br /> r <br /> This project is a new building or structure. ?f/7 <br /> Permitted Use <br /> This project is an addition/alteration to a• - Istin ructure. <br /> SANITARY SERVICE: PERUMBt ��_�O� ` 11'' •drng) <br /> EWER ,5 IStln <br /> HEIGHT IN FEET: I • BER OF STORIES. (Not including basement <br /> ZO I� A t Wetland/Floodplain/ �/�61( <br /> AREA TO N.AREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> XErosionControl permit <br /> B MENT 0 1ST FLOOR:_J/✓n /0 <br /> .050q1 q1 j TOTAL SQUARE FOOTAGE: 4, (slopes, disturbance, <br /> ND FLOOR: 3RD FLOOR: , � t"--- filling/access) 41 <br /> /t <br /> L A 'ev ..: ion Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ��� �� and •tions. <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 LNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes ao DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes QNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 111Yes 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) AIL ,:+ -s Imo Don't know <br /> 7. Is this to correct a violation? / es QNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —, —► —+ <br /> 545-112(4/08) <br />