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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME A I /-^ <br /> L'a(Ov . L.(,L yep, `TI 1M,sAl�I 3- k-.k1,ICkk C v.j'\raa t& [Zoning Status; CUP; �[�,J�'` <br /> OWNERpAD RI` S (Number,Street, ity�,'State,Zip) r Deed Restriction; CSM <br /> HOME PHONE L-640 v CELL PHONE V�q e E-MAIL uADDRESS 3 5 g-j Variance(# ` ) <br /> ■ , <br /> 6 o- t 2 , S ,, , , t 0.t.4e ' o6.4 , . . e 1 Site Plan drawn to scat= <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensi' 4755 <br /> AGENT NAME CONTRACTOR NAME L_ <br /> e2cuAdt.�Ic R `�- tAde✓ 1200.4A�.lI P.tk(.Q vt..4.t✓ I2'Site Plan including loca .. <br /> AGENTADDRES CONTRACTOR ADDRESS of well/se. <br /> 21 q 4- Lai o v 20( 3 c{S W . (,cJ ask i btq 4-0 v. A-v • G 0 o <br /> (City,State,Zip) (City,State,Zip) Q Setbacks <br /> V4.-1 O V. CO± • c 35 q-S ry oLett ® r. 04_1' s/ 10 3 <br /> PHONE PHONE li Site Plan approval from <br /> dog- 852. Slo l S 08- zeo- 0 to 7 applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> V ., .a.v1 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) �Elevatlon of property PARENT PARCEL NUMBER CURRENT ZONING: ACREAGE: p p rty a <br /> ❑NUMBER 0(0(0 -o12,--Y00&.3 t `x 8 o 5i5/1 <br /> y frontage drawn to scale. <br /> TOWNSHIP: SECTIO . / S W <br /> v`v�in n %: N %a'/a: Driveway per to-- <br /> ADDRESS: (state, count tow <br /> R� 1....040v Rd.. .«pvt✓.app ��• �ou <br /> GSM' LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits ("° <br /> �_ (public, private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> ye o cIL( a O.,V vv /6 , 66 ( /( <br /> 36 i )( 3i) Zoning District A - 1- -),i,l-E <br /> . ❑This project is a new building or structure. 2 S a--0 1--y —0 de ) <br /> 's+- Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. 5,�;r�,r- <br /> SANITARY SERVICE: PERMIT NUMBER: Fa f K- 11- Rural Atetr <br /> FIEWER IEPTIC / 1 ./ � 0 f� E 4 vi Q (new 3't_ <br /> HEIGHT IN FEET C NUMBER OF STORIES: (Not including base e a f ik L <br /> Yo ' Z- 2 vvr` w 0 V.a A ..,. .a7 , i <br /> �3 •relan. t:ttachment) <br /> AREA TO NEAREST SQUARE FOOT: �✓(��n i <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ,.� rosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> a( 3 © 0 4, TOTAL SQUARE FOOTAGE: 4, (Slopes,disturbance, I <br /> 2ND FLOOR: 3RD FLOOR: filling/access) 1 /t <br /> 2 3 O d _ 't 6 O a Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: � //�� and available o•ttons. ... J 4 <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ ,)-b�d/OV, ga ■ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ao ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? J7 Yes ON ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [fes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? aes ❑No <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 No ❑Don't know <br /> 7. Is this to correct a violation? [Yes 2No <br /> fV0 APPLICATION MUST BE SIGNED <br /> 545-112(aios) <br /> (Conti ue on Back) -+ ■ -► <br /> 131 47-14 6 /2/13' 4 / 1-114.k <br />