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ZONING PERMIT APPLICATION www.countyofdane.com ""�"'"'�`'i�•'"�'""�r�' <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> \<02R-1 2c Z , L I s 4 z�"'z_ 0 Zoning Status;CUP;ADDRESS (Numbs, <br /> Street,City,State,Zip) Deed Restriction;CSM <br /> -2(912- Ni,-)Y F , Br.). $(o 35 , ( J 1 535-17 variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> ‘'0 8 1- &o 1- / -9 7 0 Site Plan drawn to scale <br /> AGENT INFORMATION ! CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR,NAME <br /> AGENT ADDRESS <br /> 1-00650,J b u,co;J, 4, a -o (, El Site Plan including location <br /> CONTRACTOR ADDRESS of well/septic <br /> 7153 hr.'s- G1);',-)5 4 ❑ <br /> (City,State.Zip) ((CCiityypStab,Zip) Setbacks <br /> PHONE +i '" J Ek-) / WI 5.f.� O.7 <br /> PHONE ❑Site Plan approval from <br /> (G08 9 ZY-Mg applicable township. <br /> E-MAILADDRESS n/� / E-MAIL ADDRESS <br /> I't2, ��( or y , e2 IA br9 Q -Crurrhe -. Lcr+-- 0 Floor plans to scale <br /> PROPERTY LOCATION INFORMATION (http:l!accessdane.co.ctane.wi.us') <br /> PARENT PARCEL NUMBER: CURRENT ZONING/ ACREAGE: ❑Elevation of property <br /> El PARCEL 0 I o%(o o(p fl-Y130 C A -Z C8) /I-, 6 y z, frontage drawn to scale. <br /> NUMBER ll�� <br /> TOWNSHIP: SECTI N: - <br /> ADDIZ1 c) 1'4 Dd,�0s _ %4: ttil WA: et ❑Driveway permits <br /> s: (state,county,town) <br /> d6'L ,/r, ii:34J6- ' °(-'./oi ( 0/ ri-r/7 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> I gZqa / (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> F ly P..00'-'-- ADO 013 ❑ Zoning District <br /> is project is a new building or structure. <br /> Li Permitted Use? <br /> is project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER V�-�( 6EPT1C (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not indudng basement) <br /> 02 L f I- 7 u / ❑ Wetiand/Roodplahl <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ EroswnCOrrtrol permit <br /> U I L � /Z j TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLUOR: filling/access) <br /> 612 <br /> ESTIMATED CONSTRUCTION COST: Li Review available op Survey <br /> (Please round to nearest dollar) -+ "' 'r -4. ♦ -� $ and availab�options. <br /> i <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es to II I• 't know <br /> 2. Is there a wetland or floodplain on or near the property? lies n o s s on't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes N • <br /> 4. Has there been a zoning permit issued for this property i - •-st 5 years? ❑Yes Fab <br /> 5. Is this project associated with a rezone/CUP/variance '•-titian/..ppeal# Tie& <br /> (leave blank if none) <br /> 6. Is a location survey required? (see reverse) [JYes • • Don't know <br /> 7. Is this to correct a violation? Ares Fn o <br /> APPUCATION MUST BE SIGNED <br /> • ,,,,.,,V„ (Continue on Back) -4. -.o. -4. <br />