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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App It <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> KE iT(-t G 27EZ.(U 512. 1 ,►/ Zoning Status; CUP; A ) <br /> OWNER ADDRESS (Number,Street,City,State,Zip) geed Restriction; CSM <br /> .-3(;4C1 G�1Si LETO�J L�c�SS t�.�C^ St cni �/�Ri Ql E f Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (O "?--€5i'74-2c) SI r ,rtbtu r( 8 C. h l ,L.- ■j/ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> D Orre g_tit_ 2 r i'T 2. 0 . -3 . z r7 L , Itti C., Site Plan including locatio <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ACS LL 11 5 -,,,v S i <br /> (City.State,Zap) ,(Cay,State..Zip) la Setbacks 0/z 57 D/6---0 <br /> Et- 2-ttotiJ1U/ S3�> u <br /> PHONE PHONE :I Site Plan approval from t �� <br /> cW O - 2.1c. _ Kt 2 L; applicable township. /V/ <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> et 6 --,oc,t-z_ c st.,, Lti�1• Ae-t-- ,a Floor plans to scale // <br /> PROPERTY/LOCATION INFORMATION (http:Ilaccessdane.co.dane.wi.usn Elevation of property / <br /> 0 PARCEL PARENT PARCEL NUMBER: CURRENT ZONING. ACREAGE a frontage drawn property r scale. <br /> NUMBER Ol2.16911 -183 '6314--a A " ' i �.O LUp <br /> TOWNSHIP: SECTION 1/41/4: N I%[I Driveway permit <br /> 13 R4 5 rp L (g /.: S l - '`-"(state,county ow <br /> ADDRESS. i <br /> 04-1 G f;VC_ fl i.) 12o s5-i ti% it ,Sanitary p <br /> CSM LOT �J I SUBDIVISION BLOCKlLOT (public, ivate <br /> 34— Ito i e.J r-/��L Q es rAr <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION . J <br /> 14 14 ,4 ,,T/o+.) Zoning District 4 { <br /> . OThis project is a new building or structure. + Permitted Use?, k <br /> This project is an addition/alteration to an existing building or structure. . f„,,./e_SANITARY SERVICE, PERMIT NUMBER gRurdl Ad.,r <br /> EWER EPTIC (new! IStI g <br /> HEIGHT IN FEET. NUMBER OF STORIES. (Not mduding basement) <br /> IL( ,�'d �, 4 loodplain/ <br /> 1.- orelen,. °(attachment) <br /> AREA TO NEAREST SQUARE FOOT <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ErosionCOtltroI permit <br /> BASEMENT: A 1ST FLOOR. ' ,, TOTAL SQUARE FOOTAGE: ,, (SIOpes,disturbance, r <br /> `?(o`/' L Of R 1 ,filling/access) . fri, <br /> 2ND FLOOR 3RD FLOOR 92 <br /> `] "Review Location Survey Ai <br /> ESTIMATED CONSTRUCTION COST. Co and available options. . l j4— <br /> (Please round to nearest dollar) ♦ ♦ -�► ♦ ♦ ♦ $ CD o / 0 00. O a <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes EgNo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes o Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes to <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes 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) QYes 0 o ODon't know <br /> 7. Is this to correct a violation? :Yes z o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ -+ <br /> 545-112(4108;. <br />