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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE , ' <br /> OWNER NAME <br /> n /_ p <br /> OWNER ADDRESS (Number. r�et,City,State,Z -G Zoning Status; CUP; <br /> 12M f/�,� . Kek ' V/..til VA0' if VO( S3Sp seed Restriction;CSM <br /> HOME PHONE et j CELL PHONE E-MAIL l ADDRESS Variance(# ) <br /> (Di ' "Iozzo I(a0S-io(o°i`(920 I , ' t e.•St)lc(@ A^ (' Lam'`^ 04 Site Plan drawn to scale c._ <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Zvi Site P uding location A A._ <br /> AGENT ADDRESS CONTRACTOR ADDRESS we I/septic i <br /> (City.State,Zip) (City.State,Zip) Ora Setbacks 6j <br /> PHONE PHONE V Site Plan approval from (ID <br /> applicable township <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> j Floor plans to scale it <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) t,� Elevation of property <br /> PARENT PARCEL NUMBER. CURRENT ZONING: ACREAGE: <br /> ❑NUMBER 6911312 g(O 1 d$ _ I A ) 2. fl ' • ontage drawn to scale. <br /> TOWNSHIP: SECTION: '•1 • <br /> ' -1 S'i-b i 22 I '/4: Ns UV 1/4'/4: N W A Driveway perm n <br /> ADDRESS state,count tow ' <br /> i 2I Earl ( Sz,u,?t ,(- _IriC v'i1 s3-lo [/]Sanita <br /> CSM: I LOT 1 SUBDIVISION TBLOCK/LOT (publi rivet ) <br /> CSM of- o <br /> PROPOSED PROJECT INFORMATION a <br /> STAFF REVIEW <br /> PROJECT DESCRIPTION: 4 C/ <br /> tkorih if 22 n IBS-1nyvt i 1 t,)T ruk + 24 X 1 Li Aar 2 xf-AA-tra -1 ► Zoning District <br /> . ❑This project is a new building or structure. °`, Permitted ? 61 _- <br /> 1►1 This project is an addition/alteration to an existing building or structure. A `:e- GCr r1 <br /> SANITARY SERVICE: I PERMIT NUMBER: T"A "oral A,r•6,_ti c <br /> EWER EPTIC (ne existing. <br /> HEIGHT IN FEET: <br /> //if NUMBER OF STORIES: <br /> f/ (Not including basement) <br /> `d kW.-4 - tcodpiain/ <br /> relan= attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)3 BASEMENT: 1ST FLOOR: "I ErosionControl permit <br /> .q(to ,� t,I— y TOTAL SQUARE FOOTAGE: 4, (slopes.disturbance, _ <br /> v 7JJ������" l <br /> � - - -- Ming/access) ,--2W-t6OR:1atr 3RD FLOOR: i i 1 2C b7 . <br /> i IN f C/`j j <br /> S�fi '+ Review Location Survby <br /> ESTIMATED CONST CRU TION COST: ♦ ♦ ♦ ♦ ��r a� a d available options. V49.___ <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [ (Yes ❑No EDon't know <br /> 2. Is there a wetland or floodplain on or near the property? fYes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ❑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) Dyes No ❑Don't know <br /> 7. Is this to correct a violation? _ es ®No <br /> " <br /> 3 6 ® <br /> 3'-'0' <br /> • ••LIGATION MUST BE SIGNED <br /> 545-112(4/08) S' ( Continue on Back) —r —► <br />