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, . Qz3 (,)- 7P,vc_,--i- ?,c3). <br /> E-)`c- i`IA-1- -. \i\i :_ k_i4t.-vi) AkCA <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVID <br /> OWNER NAME l E <br /> �©AAr `� 4 ILA 1 e 4' p„/1 h o `t �1.'t! Zoning Status;CUP; �/ <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> .0 Z 'iv..t4..., .5".s., ei �,',/. , ./ ,--"-j'12-''*".� Deed Restriction;CSM <br /> Va .�- <br /> • - •Ufe PHONE E-MAIL DRESS L �I��6 '� —Z1� e i a kl'k0i& a-DLO f tI d" rr!l Site Plan drawn to scale f Ictt <br /> AGENT INFORMATION CONTRACTOR INFORMATION and indudesdimensions <br /> AGENT NAME C " TOR NAME /�j / <br /> a CJA4'A/�' /. L-Ov til4• ✓ 1�1 Sit- - .n"• - •ingIocation1 l v� <br /> AGENT ADDRESS CONTRACTOR ADDRESS • ._Useptic <br /> ,, <br /> (City.slate,zap) (city. .zip) Eiji 440 <br /> / <br /> PHONE PHONE ®.Site Plan approval from ,// <br /> Log—ZCI c-9g/3 applicable township. f" j�- <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> /Floor plans to scale it <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us) i\�devation of r <br /> PARENT PARCEL NUMBER:/ ,�1�f CURRENT ZONING: ACREAGE: property <br /> ❑NUMBER /D—�e ^ Fwx q P& EAG frontage drawn to scal cr. <br /> TOWNSHIP SECTION <br /> 11 ,�/5 `� <br /> 4 7'11=7 /d ;b y1. /V 'h4'Y.. /v Dri ay permits <br /> ADDRESS: (e ,county,town) <br /> h-/ 7q 1-,wy /y /// /&/y 1 i/, .� <br /> Sanitary permits <br /> CSM: LOT BDMSION BLOCK/LOT <br /> (public 441121"4 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRI N: <br /> r � <br /> �'!-�4 * �✓u� l�•t�i�-,;� Los e {���(t.5 /r-i;;� yQ`Zoning District <br /> . JThis project is a new building or structure. //8 r) c' (- 7 Y Ca 1.f f� <br /> Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. b 4 <br /> SANITARY SERVICE: PERMIT NUMBER: illi Rural . . •.. . <br /> EWER KEPTIC �, <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) /V/ <br /> AREA TO NEAREST SQUARE FOOT: — r`" r: ii4 / vv <br /> (Outside dimensions induding unfinished area,attached garages and above grade decks or porche <br /> BASEMENT: 1ST FLOOR: /� • � �� <br /> 06',24/)) 6!6 k/ 4 TOTAL SQUARE FOOTAG " 4 slopes,disturbance, D <br /> ���lffYV// fill* T <br /> 2ND FLOOR: 3RD FLOOR: I il <br /> / krReview Location Survey if <br /> ESTIMATED CONSTRUCTION COST: and available <br /> (Please round to nearest dollar) "� ♦ ♦ "� $ CM i pj options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? BYes [llo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Ro ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ales o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies 'lo <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 silo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ININo <br /> APPLICATION MUST BE SIGNED <br />