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ZONING PERMIT APPLICATION www.countyofdane.com 11.''"J'4,',14'r1EC•IL'c3;75_ :a <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ^,, l <br /> -T 6 l"k t 5 /1 t • S 1 Gi Pkd I - El Zoning Status; CUP; <br /> OWNER AfDDD1RRESS (Number,Street,City,State,Zip) c_ Q Deed Restriction;CSM <br /> HOME PHONE COI CELL PHONE M. f-ott IL��DRESS / S 3 S v, Variance(# ) <br /> CFO (/ '$- ) ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME ('''''h,....4 <br /> Boni ZLr+ é+/...Soul .4m c4icew 44r �r/,1€✓S ' Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> ./274- Enfeeensti Z '. S7(1 L,nKtvw.if 00i'• El(City,State,Zip) (City,State Zip) Setbacks <br /> LJ'CV■O"a kJ' 5--3 Sri 3 S(.4.-$ 1.64rre ,tit)I. .3 S q J <br /> PHONE PHONE ❑Site Plan approval from <br /> 6'00' • A_3 S- •/0%69 ' 64,13 ' .? te. ol-Do applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Z e 4 1* Bid- i1- 64 ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> 0 PARCEL <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> NUMBER VJI I ik91 ( I (0 A - I (e)r) frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Tj km K i N'C '/4: '/a'/a: ❑Driveway permits <br /> ADDRESS: <br /> (.O��lhS t� s�� i?�� �� 3 3 S�5 (state,county,town) <br /> / Sanita <br /> CSM: LOT - SUBDIVISION BLOCK/LOT <br /> (public, rivate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / <br /> C�Sfit�F 4 Pit,..) •��-fX Me WA,4 e/Airra pe ❑ Zoning District <br /> [ATMs project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER EPT1C (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1.4-' / ❑ VVetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: <br /> 1--, ErosionControl permit <br /> j TOTAL SQUARE FOOTAGE: ,Ir (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> T l 1 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ 43 and available options. <br /> (Please round to nearest dollar) S 2 S �. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es lac) Boni know <br /> 2. Is there a wetland or floodplain on or near the property? Yes o �on't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes LVo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Ekes ❑to <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) Ekes F2 o ElDon't know <br /> 7. Is this to correct a violation? Ekes Z o <br /> 4 y \ , ,k40 APPLICATION MUST BE SIGNED <br /> sat11�reinRi <br /> 1� (Continue on Back) —► -. —t• <br />