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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 /> V=tAitc.c� of Ve. .s i A . P;A-1A SAL I Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> ,�os Deed Restriction;CSM <br /> bb i-c-- `- r''ir=moo Si%"',_ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ‘o(3- 24 6-Oct g■kc' t) P v 1 °Dc+rocs .1..r1 . vS. ❑Site Plan drawn to scale <br /> AGENT INFORMATION !CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> �°wA%-c) 1-E0ic■ V ECLr'2, ■vsvg■is s ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> S-44 € - ucpati1 AwE. STcti6 ou'10T- \Sh1S. 'R`(t S4A-1 VV <br /> (City,State,Zip) (City,State,Zip) []Setbacks <br /> bli•,wi yt FE S-gao 2 ‘Ac....? Q tv,a CSI 51 . <br /> PHONE ' PHONE ❑Site Plan approval from <br /> Qj�v -S$S-9`d►i c applicable township. <br /> �I1y -S�$-G��� , <br /> E-MAIL ADDRESS E-MAIL ADDRESS 0 Floor plans to scale <br /> Nir s 1 e I n cteSS. co iuk- . rq -1.1.2cvV(11-2.0)a WCIlt..Vqt s,c <br /> PROPERTY!LOCAT!ON INFORMATION (http:/!accessdarse.co.dane.wi.us!) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 12 <br /> IDPARCEL <br /> NUMBER 044'10 -091-e SL3 I-`{ C-� frontage drawn t0 Stile. <br /> TOWNSHIP: SECTION: <br /> ,3 J9- 9 %,n"/ %1/4_ 0 Driveway permits <br /> ADDRESS: �1 (state,county,town) <br /> 10'09 AvA 0 w 25 444 PO ON c) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> duic-s3 'C-' 1r.t-Mt4nAAr ru-1 4C4c `0%-1 0►, -k-v-Toar ❑ Zoning District <br /> . project is a new building or structure. 1:7 Permitted Use? <br /> his project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER F)EPTIC (new/existing) <br /> HEIGHT IN FEET: 1 �\( NUMBER OF STORIES: (Not including basement) ❑ tland/FIOD Ir1/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ Eros. 01 permit <br /> BASEMENT: 1ST FLOOR: <br /> 4, TOTAL SQUARE FOOTAGE: 4, , (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> ` i filling/access) <br /> 1��- � ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ -2 -ii. $ and available options. <br /> (Please round to nearest dollar) Is o o c, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [ Yes Oslo £3Don't know <br /> 2_ Is there a wetland or floodplain on or near the property? QYes a. £Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ages Dslo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? []Yes alo <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) Wes alo QDon't know <br /> 7. Is this to correct a violation? QYesVo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ -► -► <br /> 545-112(4/06) <br />