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ZONING PERMIT APPLICATION ww.
<br /> wcountyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> '`` �``' \
<br /> ' vi -✓t IA Zoning Status;CUP; t—
<br /> OWNER ADDRESS (Number,Street,city,State,Zip) _ Deed Restriction;CSM i©�`/
<br /> 073 g7 V ✓`✓t �l ILG�• .55.7 /2/-'-‘9,1 as 5-3 ? Variance(# ) /Jo
<br /> HOME PHONE CELL PHON E-MAIL A RESS
<br /> 7-73- 46._r ,
<br /> 6"� - - _ k/1 ` °' may`i`�>rt Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR N
<br /> fycJ e &
<br /> �i�/G�. � Site Plan including location
<br /> AGENT ADDRESS CONTRAeTOR ADDRE of well/septic
<br /> vz-3 f 7 tt Ooh '
<br /> (City,State,Zip) (City,State,Zip) t Setbacks
<br /> ED 11 r�vi, w� �e
<br /> PHONE PHONE ❑Site Plan approval from
<br /> .06' _ ir:73_g , applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS pr
<br /> .. ,` ki Q,,t ‘ f-, ri d-r Floor plans to scale / A PROPERTY/LOCATION INFORMATION (http://aceessdane.co.dane.wi.usn /�
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property
<br /> El NUMBER OS//-12q/..., H,`/3--.. le / , y ./it frontage drawn to scale.
<br /> TOWNSHIP / r/ SEC O
<br /> .0 IX- ,�/ �'
<br /> t 0 K t fr &' %: // E '/4%: ' , . Driveway permi
<br /> o r
<br /> ADDRESS: /�
<br /> 7 _3 ,s'6,-re.. 4 /3i? .5/ `Z77,7 WT 4-3 5-F i f Sanitary permits
<br /> CSM: LOT V SUBDIVISION BLOCK/LOT (public, r a e
<br /> gc 5 3 Lora
<br /> PROPOSED PROJECT INFORMATION STAFF REVIEW
<br /> PROJECT DESCRIPTION: ,,f,7 `n-0,-, U lit ,. Ate-4v c eiteN /6r /,`% /
<br /> Fie,an /a4,41.17/, t�, e ;-A e. o=�,e_Ste,,,Bee-'th -6 ooprrc Zoning District
<br /> OThis project is a new building or structure. /© �O
<br /> Permitted Use?
<br /> This project is an addition/alteration to an existing building or structure. /644—.o4
<br /> SANITARY SERVICE: PERMIT NUMBER: )7, /3 y3T itlt Rural ' P /
<br /> EWER JEPTIC C 1"3/�` (new 1 r ^
<br /> HEIGHT IN FEET NUMBER OFSIORIES (Not including basement)
<br /> /6 f rJ , i ®0 Wetland/Floodplain/ ./
<br /> AR SQUARE Shoreland (attachment) /
<br /> AREA TO NEAREST •`/�
<br /> E EST SQU RE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,
<br /> PA ErosionControl permit
<br /> BASEMENT 1ST FLOOR:
<br /> (7 C Ej e TOTAL SQUARE FOOTAGE: j (slopes,disturbance,
<br /> tv O ,
<br /> filling/access) /4,10 I/
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> 42/.a 4 Review Location Survey.,,
<br /> ESTIMATED ED CONSTRUCTION COST: -�► ♦ i i i i $ D and available options.
<br /> (Please round to nearest dollar) / dOfJ,c,U
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes J.lo ElDon't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o �on't know
<br /> 3. Have you talked with the township about your project and are they in agreement? Yes LJVo
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies Rio
<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) Dies alo Don't know
<br /> 7. Is this to correct a violation? Dies a
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -+
<br /> 545-112(4/08)
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