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ZONING PERMIT APPLICATION www.countyofdane.com 1''JJ"4"I4'"M'''LI iff" ",11 <br /> PROPERTY OWNER INFORMATION C TOMER TO PROVIDE <br /> OWNER NAME ''II <br /> Zo�h C�6.4 sey a-STD E Iii 1 ki(kenay, `4 Zoning Status; CUP; <br /> OWNER ADDRESS (Number, reet,City,State,Zip) Deed Restriction;CSM <br /> 2 5S IA)hift Gknos .tcj Ik`( Vevokte,t W, 5 ISIS Variance(# ) <br /> HOME PHONE 1 CELL PHONE E-MAIL ADDRESS <br /> •OS• 84S'8 » ❑Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION _ and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> n" LAM h,�,,5y1 Arsie 'iGc i 64-41e Azsi MZ,S -le Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS •f well/septic <br /> /204- C:Kf•cv1or,'sic.1 ' S7(, L4Hnt✓Ltd De . <br /> (City,State,Zip) (City,State Zip) � qq ❑ tbacks k <br /> V�0K4 C4)I 5'3 S13 Sa+4Preti fiL wi S3S10 �Q <br /> PHONE / PHONE / Site Plan approval fro <br /> 6o& 2,3 • /13.4.e. (,J$ • u G • 04.c7D applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> oM llie. 4, - •n '1, • Nt ' • .. ❑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 /> ElPARCEL frontage drawn to scale. <br /> NUMBER f9t'.v 713 4 811 a.f A- . 1 1. 97 <br /> TOWNSHIP: SEC c (�1 <br /> 5 tOH '/4: S E 1,44: t " ❑Drivewa rmits <br /> ADDRESS: b (sta ounty,town) <br /> CSM: S co 4 h; Loin M d es. �.• S3S s3 El Sanitary . mits <br /> 3 3�} 9 SUBDIVISION/ BLOCK/LOT (p • private) <br /> PROPOSED PROJECT INFORMATION •TAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> LO a s ,:f w /LR'h 2 2' O et A.c.A erA 1j.1/4 5-G , oning District <br /> . EiThis project is a new building or structure. <br /> Permitt=: • -? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: IA ❑ RUraI FIEWER EPTIC (new/HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> /1 ' ❑ tland/F plain/ <br /> Orel (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: EroslonCion perm 0 <br /> 1 / _ 4, TOTAL SQUARE FOOTAGE: ,, (slopes Urbane, <br /> 2ND FLOOR: 3RD FLOOR: 1 �J full CCess) r <br /> 31c 40 ❑ Review Location Survey 1 v c <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ $ �a and available options. LT <br /> (Please round to nearest dollar) $ /.? g 4 S. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Ekes 'lo Boni know <br /> 2. Is there a wetland or floodplain on or near the property? es :' o on't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes 0 0 <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies alo <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) Des ►4 o don't know <br /> 7. Is this to correct a violation? ❑Yes .0 o <br /> 41. 7 . O APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► <br /> SdS_117!d/!1311 <br />