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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME f / .� <br /> ST � <br /> \J' £ essay e-�' C O J I M 1 0 oninq Stat CUP; <br /> OWNER ADDRESS Number,Street,City.State,Zip) <br /> 1081 LS t.LeTr6 -5-'357a Deed Re(triction. C 7 �- <br /> 1 ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS Variance # 1 D <br /> /.t - i3. •`i'J$ .74ItzY " b.r M L. Co, >I Site Plan drawn to scale <br /> AGENT INFORMATION i CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CO TRACTOR NAME <br /> DAV l VE'�� M(>IC < .11J C • Site Plan including location <br /> gcENTADDRESS �( ^ CONTRACTOR ADDRESS of well/septic <br /> T 47v o'er I vi WK 14 G. <br /> City,State.Zip) (C' State ip) Ig Setbacks <br /> (Qty, eTbi# \41, .Ss5IS EIAC EANtTi-I �J 1 . 53 S15 <br /> PHONE PHONE (� ��7 N Site Plan approval from <br /> CQOB-c9aO - 3 I C4 S (00 S- `1Co l-t97aQ applicable township. <br /> -MAILADDRESS E-MAIL ADDRESS <br /> I • , Mel S_ LDS .Co PO AV ■ 1 `f(5 eILDS ' Cor g Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: �/� CURRENT ZONING: ACREAGE: I p p y <br /> ❑NUMBER r .S �' - ?SO'Q a r`,LI rootage drawn to scale. <br /> r • i. <br /> TOWNSH SECTION: <br /> re h e0 5E 'A: SC: 1/41A: Driveway permits <br /> (state, county,town) <br /> ADD SS: <br /> I I a L4\0USTE fed. MT Ab Et <br /> cSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> N (public, private) <br /> Or in. <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIP ION: 1 1 <br /> NEV.' M 00 S6 ❑ Zoning District <br /> This project is a new building or structure. LI Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: LI Rural Address <br /> EWER KEPTIC I3 aOIS 0010 1 (new/existing) <br /> HEIGHT IN FEET V ep I NUMBER STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) I—, ErosionControl permit <br /> BA�e Li 1ST FLOOR: � - <br /> -��/�-7L�PJ�t�I' <br /> Z-4,,C�7 + TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> Q 3RD FLOOR: �/ filling/access) <br /> arveACrf. -/O 3 ` 6`3( ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ^A� and available options. <br /> (Please round to nearest dollar) $e)`I I I l.JI e <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes KINo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes i o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? NYes /No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes ligiNo <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) Dies M o ❑Don't know <br /> 7. Is this to correct a violation? ['Yes '.4 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112 14/08) <br /> sST-ic- coo tra_ . <br /> 1196 rzzto <br />