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I L C1 ee eM.''IT )'o — f t- ? <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME beCEZA,t` _ Wing Status;CUP; <br /> ADDRES (Number,Street,City,State Zip) <br /> N I di 4�etas Deed Restriction;CSM <br /> t )Ij7� Variance(# ,0,LX <br /> HOME PHONE CELL PHONE j E-MAILAD SS <br /> 11 _ I 'a a" Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR <br /> INFORMATION includes dimensions W A NT E ,Y/ ��� p n , CONTRACTOR NAME <br /> 6 cev opmeo-r Sit an inciudingloeaiion <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ,State,Zip) <br /> (City,State,Zip) tbacks <br /> id tAP Pirtirri S \NI i 551-1 bILit.WCIArCtSj \AI i 6_5i lc ,,, <br /> H(O,NEE' PHONE 0 Sire- ^:".proval from <br /> UIV?7 ) (.al c5.1 ( Q0) 451 ( ( appli;.i. - .wnship. <br /> E-MAIL ADDRESS E-M'IsrD'DRlS 1 rpjOp�ON Cm El ,oor plans to scale <br /> Jf� �i V . 'V1' <br /> PROPERTY/LOCATION INFORMATION thttp://accessdane.co.d i, E ation of pr�o�ert� <br /> PARENT PARCEL NUMBER: CUR-ENT • IN : ACREAGE:❑PARCEL r yr- r • A 3 I outage-cdF'awQ to scale. <br /> NUMBER 1/ '� I' �_.I v 11/���! — / <br /> TOWNSHIP: SECT 0 : 9 <br /> g'eV H e %: ,.. '/'/4: Driveway permi <br /> DRESS: tote, COUn town <br /> a932 urYor I <br /> E'Sanifa��-pc <br /> CSM:` LOT SUBDIVISION BLOCK/LOT (publi- private <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: �, �-�-•New Co� �al D) 'Z. aldning District <br /> This project is a new building or structure. ,� /�.-� <br /> L�'Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Ad <br /> EWER PEPTIC 13— 6 5-- 00 )--75 (ne xisti <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Coup 16-31 v 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) ErosionControl permit <br /> � BASEMENT: 1ST FLOOR: <br /> 11 _ J d2 n U Jl ,, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> < 1 &et Yao i-V l P,(Oh et Dec c filling/access) <br /> Oil +AP 52?) - L3 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: i -► r-�, 2 ✓v and available options. <br /> Please round to nearest dollar I <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes j/� o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Oyes +'. o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es /P o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes glo <br /> 5. Is this project associated with a rezone/CUP/varian,ce_.(jsietition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required?-(see reverse) [Yes "! o ❑Don't know <br /> 7. Is this to correct a violation? Elves P' o <br /> r!. <br /> .,, y\X V �rz,c S I i t rl' APPLICATION MUST BE SIGNED <br /> (Continue on Back) —+ —+ —► <br /> 545-112(4/08) <br />