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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME ,
<br /> "ito,,,,,,,c.,„0 0,,„-4., (7. ?0 i k,i4,..1),v 0,......; .t. — ) [J Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Stme ity,State,Zp) Deed Restriction;CSM
<br /> 5O I F c.4 0.-k 1) / Variance(# )
<br /> H0tiNEVPDNE I CELL PHONE E-MAIL ADDRESS
<br /> Z 2,te- 34-. , -.i C]Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME r t
<br /> "slit„tY1-4 Allie Lot 1L47 ir cr op vet 4---o,vr tie..-5,it ia 1 ID Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> 5-„Z 4 i Fe.4,4 ()..4.. 0 ,... liZzie ici .2 S-- is)g pi.kt
<br /> (city,State:Zip) .,,,, (City,State,Zip) 0 Setbacks
<br /> -5- 3 '71 -e- itLe...",42c,,A /...41/ 5-37 t i-...
<br /> PHONE PHONE 0 Site Plan approval from
<br /> 6 z:, 7 - 3, 2 4 — 5 4, i ci 407. 2,25 - A 11'1 3 applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS gr-fee-4.4:4•01.eies4. r-i
<br /> 4c uoi 1,4 v'T .e0.44.4.. 0-604.4c —*I k k ..4/ v S4044.p L---1 Floor plans to scale
<br /> PROPERTY/LOCATION iNFORMATION (h tp://accessdane.co.dane.wi.us/)
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 0 Elevation of property
<br /> frontage drawn to scale.
<br /> 1:::1 PARCEL NUMBER e> 5 i 2. -/ ..33-10- 1-4 r-t/1. > ..io „c,c.... _
<br /> TOWNSHIP: SECTION:
<br /> AI1,t; .L. , v.: %%: 1 Driveway permits
<br /> ADDRESS
<br /> (state,county,town)
<br /> .
<br /> 1 1 5'i /Uce . 4. .9.e 4.). I El Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private)
<br /> PROPOSED PROJECT INFORMATION '''!!:'4'STAFF RMEIN
<br /> PROJECT DESCRIPTION: .e.' . . . , ,
<br /> :$.1 1:4:Nu- k 7 *4.0.4.-' (io,44.t 40 /1404 c ,,,te 4 4, t) • .14-zorung District
<br /> i. .
<br /> . OThis project is a new building oistructure. rtt k" 17') ' ''''',.., a Permitted Use?
<br /> lirThis project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER LI Rural Address ,
<br /> EWER FIEPTIC (n-'i0,Illt59.
<br /> HEIGHT IN FEET: i NUMBER OF STORIES: (Not including basement)
<br /> /t.,- 2,, a ( i ,tetbt ,-.) 0 Wetland/Floodplain!
<br /> . .. Shoreland (attachment),
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)
<br /> - Ci
<br /> BASEMENT 1ST FLOOR. ErosionControl permit
<br /> 7 2 1 I 5c10 4, TOTAL SQUARE FOOTAGE: 4 ' (slopes,disturbance,
<br /> fiklgiaccess) ''',.`•„,
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> rei(404--- At ier,,. Z15 ,2 F
<br /> . ,
<br /> .,1:3?;,!eitiew Location Survey
<br /> , .
<br /> ESTIMATED CONSTRUCTION COST: ,le.„...and available options.,..
<br /> -10- -40 -+ -+ -
<br /> (Please round to nearest dollar) -, 0 $
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Lives Rio DDon't know
<br /> 2. Is there a wetland or floodplain on or near the property?
<br /> ElYes [ No ODon't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? EYes al.
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes Eat°
<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) Eves 72 o ElDon't know
<br /> 7. Is this to correct a violation'? ...........................,.....................,.........„.......„................ Efres ! o
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -4. -O. -40
<br /> 545-112(4/05)
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