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ZONING PERMIT APPLICATION www.countyofdane.com �1•,uu,a,;Ia ;.>..�a.�_,.r:>t:� <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAVE 1 //)� MFG s', C. r.'y ' vs <br /> EA C,k4rI CFO l/a/rt i4' rC� S , L L L (,J4de 65S1�}-, 1C <br /> � Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,CC j, ate,Zip) 1 Deed Restriction; CSM <br /> S a 76 SCPNIC, /2 i ye �ru ( ti ,'� Je tom,.} �S'3S(oZ Variance(# ) <br /> HOME PHONE CELL PHONE i E-MAIL ADDRESS <br /> (,scd 2_2.Y--2.% ci' 5�-, . fr ,'r5(.—( v - Pi 4; (r L. Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> VA Vnwq et- 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR DRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) 0 Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PD ARC LNUMBER: CURRENT ZONING: ACREAGE: <br /> Elevation of property <br /> ❑PARCEL frontage drawn to scale. <br /> le. <br /> NUM BER X36 a8/ z/ _( F xCLuSl , 13 <br /> TOWNSHIP: SECTION: <br /> Ike rr7 3Y) ,/a; 4n: Driveway permits <br /> ADDRESS: t (state, county,town) <br /> 50 Y7 E.„4.Q41t�,}. N117 /1) Gc:,5 s pit ,:,c 1A■gC <br /> CSM: LOT r SUBDIVISION f BLOCK/LOT El LOT permits <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DScitIPTION: <br /> U i d n-N 6-i A-1 / i Y C k d-- fZa r fps ❑ Zoning District <br /> . ❑This projec''Ts a new building or structure. <br /> ❑ Permitted Use? <br /> ,his project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE �.A-- PERMIT NUMBER: ❑ Rural Address <br /> EWER 1EPTIC (new/existing) <br /> HEIGHT IN FEET 1 �� NUMBER OF STORIES: (Not including basement) <br /> 7 <br /> ^ <br /> I ❑ Wetland/Floodpiain/ <br /> Shoreland (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: <br /> ❑ <br /> Li permit <br /> -'9-.- -Z___ j TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: S� filling/access) <br /> 6.17.4_4_,(-t--- �vC� ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) 10 csb° <br /> 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es t�- '� on'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? Efres o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Des EP <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# Z 2-31 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Des No �)on't know <br /> _ <br /> 7. Is this to correct a violation? Des No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -* -► -i <br /> 54F_117 ldlllR\ <br />