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-tk. 5 '1 7 eFiratct- e Vedt '- <br /> - <br /> SUPPLEMENT to Web-App # <br /> • ZONING PERMIT APPLICATI N www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> DAr-1 C C o L,,..rry (r,3g0..t,c_ w 0 12-,tLS") n Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> lo MA'4LI-'t_ t,.-.u-t-4 FR- 1.1 rJ L 13 -VD grA IN Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 606 ?_(o'1 0 II ' EbE ,.v cFDAr lE•C-erY% VI Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> -pat a_Aa-tF cb% t 6 a &s c. , S 1i, S uSIorls ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (2-Po E. \if-?-0 r.stIN AJE 3 kb L C T DRiU I <br /> (City,State,Zip) q (City,,State,Zip) ®Setbacks 3v <br /> PHONE ?-)14 A' W 1 5'35 1 3 PHONE VE.�e-0tJ w i �35`13 �l <br /> `' Ll Site Plan app roval from <br /> f3 LI S—2-999 q la — Igo a applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Mit..Q. St E--714•GoM IP•ti1'6 U SC-l' ; SIt -c.cow ❑ 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 /> n PARCEL q� n frontage drawn to scale. <br /> 'E"NUMBER �2/Cro�-f�}Z^ I5O2-"'b �T_-j 2. 1.9 <br /> TOWNSHIP: SECTION: <br /> 14 '/4: 5E 1/a'/: /jW ❑ Driveway permits <br /> Ni E-2-0,---1 A (state,county,town) <br /> ADDRESS: <br /> 12,00 E. q E-V--eit-bk f}'Ie <br /> n Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> (11/4-1Cing-c_1-.. 'Z. S t t.r-.1 S (-- DricriE co vr`-►7-y e—iI-,Ty/ ❑ Zoning District <br /> . <br /> This project is a new building or structure.1 5 (,).15 ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANIT RY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> E R [)EPTIC (new/existing) <br /> HEI HT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> r 1I i ❑ Wetland/Floodplain/ <br /> e?—1 A1� - r 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 /> ErosionControl permit <br /> 31, 'W 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: $ 1/000 and available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies MNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? NiYes ❑No off,-- <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No ? <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 r,2INo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -i -► <br /> 545-112(4/08) <br />