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4-7p2L?8 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME a <br /> f-1 a VLY ' t .0 0.Y'V.1 Toy UV\6.C� ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Mather,Streets,City,State,Zip) Deed Restriction; CSM <br /> —1 /I t R%vev-side Ikc• Ve trc &. L I. S 3 5-93 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> -c:•%45.43y' 1.w.-5")o as'3M ❑Site Pl dr ntoscale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and inc es dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan Octuding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well ptic <br /> (City,State,Zip) (City,State,Zip) ❑Set CS <br /> PHONE PHONE ['Site Pla ap r I from <br /> applic n hip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑Floor plascale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation Qf pf�perty <br /> ❑PARCEL /� frontage drla�vn to scale. <br /> NUMBER 01, -06,07-331-23.5-.1Y-9 Resrdewh"-, r /7Gr� <br /> TOWNSHIP: SECTION: <br /> 1-0 wiN. e7 Cr \(e rov. 1/a: /41/4; ❑(staew pe lts <br /> ADDRESS: Q (state,CQI.Frfty,town) <br /> '1 �\\ ,.vev-s :Az. i\� • ❑Sani .1r..• . � 1-1 <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (pu ic, •riv_ e) . <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> G-Q••-e...5 e- 4dAZA.e,.. Ii '0;1 ❑ Zoning st' <br /> ['This project is a new building or structure. ❑ Permitjted/Use? <br /> 'Phis project is an addition/alteration to an existing building or structure. �V/ <br /> SANITARY SERVICE: PERMIT NUMBER: A r ❑ Rural Address <br /> EWER N E P T I C (new/e*g) <br /> HEIGHT IN FEET: Aro AREA TO NEAREST NUMBER SQARE OF STORFOOT:KS: (Not including basement) <br /> ll ❑ Wetla • ;Tie•dplain/ <br /> Shor:j�,i.' - " -chment) <br /> U <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ ErosiglC�yl�rol permit <br /> BASEMENT: 1ST FLOOR: �s, <br /> t <br /> v!/ 4, TOTAL SQUARE FOOTAGE: y (slop , rbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> )-61 ❑ Revie`+ •P. io. =urvey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -► ♦ /- �.1 and .,. ∎•le •tions. <br /> (Please round to nearest dollar) C� v <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes E 1 o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No [✓7Don'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? ❑Yes ❑✓No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# r70 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ENo ❑Don't know <br /> 7. Is this to correct a violation? Elves ENO <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i ■ -► <br /> 545-112(4/08) <br />