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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 /> To tin K I aback ck, Zoning Status;CUP; <br /> ee <br /> OWNER ADDRESS (Number,SHIM.City,State,Zip) Deed Restriction; CSM <br /> *1190 Etc e r Lane , Ste, Pratt r ie , W T 53590 <br /> —... __.... Variance(# ) <br /> HOME PHONE r CELL PHONE E-MAIL ADDRESS <br /> 06-35. -WO i 1,1 A - '06-14 Q O, tS' i 5. tom a Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Hiw i Zon t veloprwttiA GirWp tic.. .1-tori 2ov% COKSivuC4rer% Gi'O4(3 i Tvt .e Plan in Judi g location <br /> AGENT ADDRESS <br /> CONTRACTOR ADDRESS � of well/septic <br /> 51,0 ► Eas4 if(race Dv. 4 300 51.(>1_,C, �1tr',race Dr �, Mod.l�n <br /> (City,State,Zip) <br /> (City,State,Zip) ._-- W( 531f3 etbacks <br /> VVV .d,rSo1, U.) 5-3r/I$ <br /> PHONE PHONE 0 Site PI a royal from <br /> (908-39'- -Mot. (00e- 354 -ociOu applicab ownship. <br /> E-MAIL ADDRESS ( E-MAIL ADDRESS r <br /> S.1`wt CA'ISll 6�ori sorsatuv-1-c'" •. b(12 w IZOrczo,n dim .covh oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (ht tp://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: "SS CURRENT ZONING: ACREAGE: evation of property <br /> ®PARCEL ar 1..1 11, ,+ j C*^ )f). frontage drawn to scale. <br /> NUMBER �`-- 7 L■ <br /> TOWNSHIP: 11.Z; <br /> ^s53z.- 3 (sfte ECTiON: <br /> tr t s1-al -3 '/4: N E <br /> /+/. ❑Driveway permits <br /> T—— — (state,COUn 0 ADDRESS <br /> Elder Lie �- <br /> CSM LOT / BDIVISION BLOCK/LOT <br /> Sanitary •-rmits / <br /> i <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> A'' •Trainivi, (-ouI 4 - P ui -cos l,ns4vuc4io� p4,,irposes V47ning District <br /> This project is a new building or structure, [24mitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> �. PERMI..__UMB !Address <br /> SANITARY SERVICE: PERMIT NUMBER: � i .._- <br /> (3-20 _....-v01_'T..._ .......__........._.... a existintsik...4. <br /> EWER �EPTIC � � �-�-' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Os' 2'" IC - --j Floodplain/ <br /> �....__....._. —_... .._............................__..............................._........_.._......._......__...................................................._......_.. :eland (attachment) 4 <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> _.__._........_.._...__..._.,_......._..._._....__ . rosionControl permit _A <br /> BASEMENT: 1ST FLOOR: P <br /> 0 i5;731 S ,, TOTAL SQUARE FOOTAGE: 4, (slopes, , a / .• <br /> 2ND FLOOR: 3RD FLOOR: <br /> fillip /acce- - ob <br /> ..._....._........__._.._._.__. 15/131 eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options xs <br /> (Please round to nearest dollar) $ 1‘ 135 ,10(1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? N3Yes alo ❑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? Yes V0 <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies alo <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) Efres sNo ❑Don't know <br /> 7. Is this to correct a violation? :Yes EN <br /> 13 APPLICATION MUST BE SIGNED <br /> 545 uz laios; (Continue on Back) –I. –t• —► <br />