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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME I/ n CUSTOMER TO PROVIDE <br /> OWNER ADDRESS'(Number,Street,City,State,Zip) ❑Zoning Status; P; <br /> 4 lIP °Kee &f,.C '�4, }, c�.'_l , 3s s - Deed R stri on; CSM <br /> HOME PHONE CELL PHONE arianc ) <br /> E-MAIL E-MAILADDRESS <br /> ,# 77-y re 3 -I le-•vrh„;6-7 y`4°" (0,°Zf 0 Site Plan raw scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and inclu imensions <br /> AGENT NAME CONTRACTOR NAME <br /> T%II 74©4w'l(/'qL'Pr/4 -)>n S%;'j"Z 44 4fe' s IL G- 0 Site Plan. clu • g location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/se t <br /> 21`1 7�L Co, /1.4.7'¢I ii r F j44.14, S-3 7 ii - <br /> (City,State,Zip) <br /> (City, `�Q / (City,State.Zip) D Se a s <br /> .p `F vv l 6,„/- 0; s 3 j// t ( r <br /> PHON �J c� PHONE ❑Site Pla r from <br /> (& P ) cy `-, , j/, C ,, aPPlica e t wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 'Ts 5®:-+ '/411 frrq itoo,e r l'it c L i <br /> ❑Floor plansicto,scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) �// <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 0 Elevation of p erty <br /> PARCEL U>O 30�_ frontage n to scale. <br /> NUMBER sP �p 7PQ-a /�� c� s p g <br /> TOWNSHIP: j',�. /� /1( a� SECTION: <br /> // <br /> //€/ • �J �/4: 5 114: #E ❑Drivew <br /> ADDRESS <br /> �,`F / (state, ci , wn) <br /> 0 ' 't- -il -ems C:e,.�./,�- 3U5( <br /> CSM: LOT SUBDIVISION 1 BLOCK/LOT ❑Sanit ry its <br /> / cf,cHn 6.1-red:'T-avY - (Pub e) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: STAFF REVIEW <br /> t?V'r 5 % L'i"e `�� s`/ /r /4 ❑ Zoning District <br /> Its project is a new building or structure. <br /> ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER REPTIC /3 ._ a-04.6-- eU /3 A (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not induding basement) <br /> 36, p 't a ❑ Wetland/Floodplain/ <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: Z a•sa ❑ ErosionControl permit <br /> /6 3r , ,Ps-7 + TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: / 3/y 3RD FLOOR: • 6.,5- 5/3060 <br /> ESTIMATED CONSTRUCTION COST: ❑ Review Location Survey <br /> (Please round to nearest dollar) -► -► -► -► -i -i $ 4�®��� `OG and available options. <br /> 4 q ess. qs <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYeso DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes j 'o QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? QYes !e.,• <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes ale- <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) Dyes OW DDon't know <br /> 7. Is this to correct a violation? Elves [IN r <br /> APPLICATION MUST BE SIGNED <br /> 545-112 la/osl (Continue on Back) -4. -► <br />