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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 /> -Fm ' Ch f 'L.. U,1 _❑ Zoning Status;CUP; <br /> O NERAD 4jY\(N r,Street,City,State,Zip) <br /> i l� . V-be /�/� Deed Restriction; CSM <br /> D t `( ( Varia nce(# ) <br /> HOME PH NE PHON E-MAI ADDR <br /> .g-$ - -.:: a 9 . r nn ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Tier`f :ek\ /14)i---.1',C cA °3rU5 '-S ❑ Site Plan including location <br /> AGENT ADDRESS CONTRAC O ADDRESS of well/septic <br /> 60S-o:v`s, ,5-t a :S.b-ivkc 5--f <br /> (City,State,Zip) (City,State,Zip El Setbacks <br /> IAua rtak t m. 6351 -/- [irk Al ee Wr <br /> PHON ^ PH NE ❑ Site Plan approval from <br /> 6&-big-61)b j5.-5j-5Y.1 I( applicable township. <br /> E-MAI ADDRESS E-M' LADDRESS <br /> ,o. 4 IA...A • 1Li < r" . _ sI`. I . • J� ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL Q �/���%jj y /� ^ frontage drawn to scale. <br /> NUMBER 8/a ' _s-gd i. C S��jt <br /> TOWNSH P: SECTION: <br /> /�f ( _- 1/4: 1/41/4: ❑ Driveway permits <br /> ADDRES : (state,county,town) <br /> //��// Mt� <br /> `�1� �1�J �� NS ❑ Sanitary permits <br /> CSM: LOT ` SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION 1/ STAFF ' `' <br /> PROJECT DESCRIPTI <br /> 6 V\ 14 64(\k-r01\ on ek�� t wt AwAi. �Ing DIS� <br /> % /4-''''',.. <br /> • ❑This project is a new building or structure. <br /> Permitted USe? <br /> s project is an addition/alteration to an existing building or structure. <br /> �r � s . <br /> SANITARY SERVICE: PERMIT NUMBER: D Rerec r'e'p " <br /> SEWER EPTIC (newief ' <br /> r <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Wetlan. a".a,• <br /> F Shorela d (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) Q "� ntrt <br /> BASEMENT: 1ST FLOOR: nor <br /> 7� 1 TOTAL SQUARE FOOTAGE: y 14:':-:s ,* ,` <br /> �0 �l// fIrn S .: <br /> 2ND FLOOR: 3RD FLOOR a , _ <br /> (,/� .C s Location�ey <br /> ESTIMATED lease r CONSaRUCTION)COST: $ / '5 <br /> Please round to nearest dollar) ♦ ♦ ♦ "♦ ♦ ♦ y „ { � �i�� S�' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yeso ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 2ces ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes _1211.o <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) ❑Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -♦ <br />