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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 /> at,v1 4 <br /> OWNER ADDRESS umber,Street,City,State,Zip) oning Status; CUP; <br /> NJ �i,3 ,e)AMcY1 to`, Q r j 1� I/ _. ,35�- g Deed Restriction; CSM <br /> �`Ge �l J Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRES <br /> 7/ --aa-3,L1 ,,h..„"7 C%reit.t ,Arr,51o,vJ)J-e/IOC .ca,+1 ' e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and in des dimensions <br /> AGE / COL%/ TOR NAMyi <br /> !� S g�l �m / ) /c0 5 Si Plan including location <br /> AGENT ADDRESS // CONTRACT DDRESS wel eptic <br /> Ot 1 i cz p' al a -. /`q6 041/ J A <br /> i (City, te, ip) (City,"St te,Zip) S backs <br /> cw;s. _.1-'2_ L/o/9 Vri o Lod' x''3523 <br /> PHONE PHONE ❑Site Pla royal from <br /> �'770'0S G--62f^gy3--97276 ap ' le wnship. <br /> E-M/�ILADD // E-MAIL ADDRESS // <br /> gvtGo('l€a4 •6.//0/1 a •/crw/ c e O led„ b,,,,'/oa,.,S.,a,24 oor laps to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) evation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> ❑PARCEL R Sq�� frontage drawn to scale. <br /> NUMBER C) ) - /� q 060 (^- / -3. <br /> TOWNSHIP: D SECTION: <br /> -72)e....,. <br /> on e Zae/ l°` l tri '/4: iki 6 1/1/; ❑ Drive ermits � <br /> ADDRESS: <br /> (state, nty,town) <br /> 36 3 /44 tri /7 L`ue. Ai 3 anitary permits 6/ <br /> CSM: LOT 1 SUBDIVISION BLOCK/LOT (public, • <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ,SOX$DX /s8„ X p 10", ,D /66 , oning District <br /> . This project is a new building or structure. Q,P‘mitted Use? <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: lij Rural Ad• - s <br /> Ett,c44/ER FIEEPTIC (new/40 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> as 's" / 0 Wetla / odplain/ <br /> Sh (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: rOSIOnCOntrOl permlt� <br /> VOtO 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> Lif, eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ --► ♦ ♦ ♦ $ C and available options. , <br /> (Please round to nearest dollar) $ lta�/ ID /t In <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pon.d or lake? :Yes do ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Y s ENo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Ls ❑ <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Efres ao <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank i one) <br /> 6. Is a location survey required? (see reverse) [Yes ['Don't know <br /> 7. Is this to correct a violation? ['Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545-112(4/08) <br />