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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU.TOMER TO PROVIDE <br /> OniER NAME <br /> bc-,Ace. 9-6 b '^- 11 em ck.^^ m ping Status;CUP; <br /> OWNER ADD SS (Number, eet,City,State,Zip) <br /> ,ZIy I 1& n&_ k n Cotti eG(o J - � £ 27 eed Restriction; CSM <br /> .•dl d� Tt f ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> • 3 ' 0 i Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION td includes dimensions <br /> AAGE�NTNAME CONTRACTOR AME A L <br /> (Je th.u.J cva;,s 4-Whja.,j -pv t �5 '4 eti.`i ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS �J f well/septic <br /> (City State ip) (City,State,Zip) Setbacks <br /> Ntc, IsC lo..) -53716 <br /> P NE I PHONE [(Site Plan proval from <br /> 0Fd l -Woo I akplic le township. <br /> AIL A DRESS r_ E-MAIL ADDRESS <br /> d _ta76 pcc• 10 Li.h W) loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) IevatlOn of property <br /> PARCEL NUMBER: CURRENT O IN ACREAG : p Perty <br /> ❑PARCEL ''.^�// f Qy��� J� frontage dra to scale. <br /> NUMBER 04iI- l i- 105 L II S,FLI <br /> TovApHIP: SECTIOry� i 1 <br /> 1Iri-e �v—i' 0C I ,�� I v '/4: i )e WA: td c ❑Drivew per s <br /> AD RES n r" / }�-- �� (stet ,co y,town) <br /> (A-1111 ICI r''^a t 6l C�r©Ve i (A £Z227 ❑ ..nit permits <br /> CSM: f LOT -"SUBDIVISION BLOCK/LOT .ublt ,private) <br /> 01. 7. <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: n y �/ <br /> 3LA,•.rcx�v� U,�G C 107 0 'oning District <br /> . 1 this project is a new building or structure. <br /> ❑ Permitted - -? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: LI Rural • •dress <br /> EWER EPTIC (new/e • tine <br /> HEIGHT IN FEET: i NUMBER OF STORIES: (Not indu ' basement) <br /> 3 I ❑ Wetland/F odplain/ <br /> Shore d (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 3 ❑ Eropes, •ntr ermit <br /> j TOTAL SQUARE FOOTAGE: + (slopes, • urbance, <br /> ` filling/ cess) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: . Q� n� and available options. <br /> (Please round to nearest dollar) $ 146 u <br /> 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes Ilo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes g, o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes n o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ON <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) Efres Rio ['Don't know <br /> 7. Is this to correct a violation? [Yes IONo <br /> il --- APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -i <br />