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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CU=TOMER TO PROVIDE <br /> OWNE NAME <br /> C'^CA^ J ('1/rt. ; Zo Ing Status; CUP; <br /> ER ADDRESS (Number,Str City, ate,Zip) <br /> 9ed Restriction; CSM <br /> 3� 77/14V ariance(# ) <br /> HOME PHONE i CELL PHONE E-MAIL ADDRESS <br /> / . ”---/ to Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGEN]NAME CON RACTOR NAME e / r <br /> 0 115 �� //AA,� v�' u�4r,, e /v, JAC IYe Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS / i of well/septic <br /> W/ 1/1.0� S-f —SO_ �..e, <br /> (City,State Zip) (City,State,Zip) Nietbacks <br /> ado=64/4 �..z- 35-33 ,....5a 4%--• ••) ❑ .r <br /> PHONE / PHONE Site Plana oval from <br /> ‘01- s ir SW 1_3 %.5--.)3f applic towns ip. <br /> >�� <br /> E-MAIL ADDRESS ; E-MAIL ADDRESS <br /> / / ❑Fj{oor pl s to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) QJElevation of property <br /> PARENT PARCEL N BER: URRENT ONING ACREAGE. <br /> Q(`( ( T/� frontage drawn to scale. <br /> El PARCEL <br /> NUMBER �vv` �v -�J / / li�I \l L � g -- ' <br /> TOWNSHIP: <br /> SEC l I <br /> 14:___c _ %IA: -S E. <br /> _ ❑Driveway rmits SS✓nl',74el (state ounty,town) <br /> n) <br /> AD j S: <br /> 1,/7/ /C'O ❑Sanitary .-rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (p-b1'■, private) <br /> PROPOSED PROJECT INFORMATION TAFF REVIEW <br /> � <br /> PRO T DESCRIPTION: I �e <br /> �Ort/t J�' , /U,-7 GO V IP • oning District <br /> . ,iThis project is a new building or structure. �Permitteyf-de? <br /> ❑This project is an additio Iteration to an existing building or st uct <br /> SANITARY SERVICE: PERMIT NUMBER: ' ♦ ( T ❑ Rural •.dre- <br /> EWER EPTIC (new/a. ISt) •) J/ <br /> HEIGHT IN F ET. NUMBER OF STORIES: (Not i cluding basement) ! <br /> ') 6 // / ❑ Wetland/F odplain/ <br /> Shorel d (attach nt) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionCOn I permit <br /> BASEMENT: 1ST FLOOR: O turbance, <br /> (�/JO ci 4, TOTAL SQUARE FOOTAGE: 4, ( op <br /> es,T Iling/ cess) <br /> 2ND FLOOR. 3RD FLOOR: <br /> t�0 C Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ and available options. ,` V <br /> (Please round to nearest dollar) $ t�� C�U <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes ,No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? _es to <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ETes Jlo <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) [Yes 2lo ['Don't know <br /> 7. Is this to correct a violation? Yes Ao <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i -0 -♦ <br /> 545-112(4/08) <br /> ___74 t_i lc ____ <br />