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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU•T MER TO PROVIDE <br /> OWNER NAME <br /> ru 2Qer f&✓ L!V//!A 7rv1, 1/4 Zt L P y Z ning Status; CUP; <br /> OWNER ADDR SS ((timber,Street,City,State,Zip)/J p eed Restriction; CSM <br /> gy,c 655erk 4rY7I d& Or Ve V7OY)k, t!( 5.35/3 a 'ance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> s7� y3? ' ❑S. a Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> /7(1)7111U. • S T E 1 4 0 9(/7 f 2 'L e q, y 206744 7 yle (0/er it Plan including location <br /> AGENT ADDRESS A CONTRACTOR ADDRESS of ell/septic <br /> y905 622/C>� �9,(/k Po, Hoe 930 ZZo <br /> (City,State,Zip) (City,State,Zip) acks <br /> /VMD T6'71 T S3S`2 Verona- W S-3c?3-0220 <br /> PHONE PHOI t Plan approval from <br /> �� 5 7c �� 775' y 7 y7/ 9700 <br /> plicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> A- ‘ aOI C ) Neu 6v,(c(,n- . coM oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) JIevation of pro pert <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P p <br /> PARCEL frontage drawn scale. . <br /> NUMBER ds`1�O(p0 1-27 y' �O$J-� A J Z ACS{ 9 <br /> TOWNSHIP: SECTIO <br /> 5P2(N(�DALe /4. S F' wh: i\} ❑ Driveway rmits <br /> ADDRESS: / , / (state, unty,t "n) <br /> g`1'J t f-5Se/Sr "x711+ ,nf h�7it. (A)-2 53'5-" ❑Sanitary rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT •Ubll , private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / <br /> ,�>'s r de/4-(a] ,oeG,�,So 1 &/i_o //i/ CO �� - 1-ra a oning District <br /> . giThis project is a new buildi or structure. '! Permitted, se? <br /> This project is an addition/ Iteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rur. Address <br /> FIEWER EPTIC l (ne ems no <br /> V\.J <br /> HEIGHT IN FEET: r ti ( et NUMBER OF STORIES: (Not including basement) <br /> L'C peak l9 Y Avg 4 /f to i ❑ WetlandlF odplain/ <br /> Shorel d (attar ent) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> B <br /> ❑ ErosionCo of-permit <br /> BASEMENT: 1ST FLOOR: <br /> (VJ) 4: 1 2 6,gg s9 c'1 1 TOTAL SQUARE FOOTAGE: 4, (slopes, sturbance, <br /> 2ND FLOOR: 3RD FLOOR: lfilling/ eSS) <br /> .26gq 5:7 ef: <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) ..4 "+ -+ -+ - $ 7d 000 . pU and available options <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes WINo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes MNo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es No <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) EYes No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes fi]No <br /> (7.."---t i <br /> GO APPLICATION MUST BE SIGNED <br /> 545112(4/08) 51 r (Continue on Back) ♦ -� <br />