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, <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> ER NAME CUSTOMER TO PROVIDE <br /> coo D(_\,. L <br /> 211,1t41 t- <br /> (Nu city . .Zip) Oning Status;CUP; <br /> n e. 2JS / Deed Restriction;CSM <br /> HOMj1DRSTTIc PHON / Y � S W I S ✓� <br /> E CELL P E <br /> Variance�(# ) <br /> AGENT INFORMATION ite Plan drawn to scale <br /> CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME <br /> Mirldlictikill AGENT ADDRESS . !li 1 !� Site Plan including location <br /> IRA{`CTOR DRESS �j I /yi �/� j of well/septic• <br /> (City,State,Zip) ( { ,`1 Myatt�l'lNl�� l v l.i 4�'4�PHONE t0 s3c61� Setbacks <br /> P �'7` 14cD 11 ���1// _1 cEE$ite Plan approval from <br /> 0 0�)� <br /> applicable township. <br /> E-MAILADDRESS E- •1 ADDR-,.S <br /> 0 1i 0.ioor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> ElPARENT Pt4[2CE U BER: CURREN ZONING: ACREAGE: In Elevation of property <br /> PARCEL 1(Jt 1 6��r li, 0 1 ,.G , , I frontage drawn to scale. <br /> NUMBER I <br /> TOWNS 11 Si- / SEC <br /> . / 1 l./rivewa NIA- <br /> /.: Nit /,�: IV L y permits <br /> ADDRESS: state,county,town) <br /> l( 7 ES tt <br /> ail i GU <br /> CSM: LOT SUBDNISION BLOCK/LOT Sanitary permits <br /> / , i U e � (public,private) <br /> PROPOSED PROJECT INFORMATION .. <br /> PR T SIPcT �N�.) ` ff'' a STAFF REVIEW <br /> �" '`�- 1AVWY 0 c 1114 j./I 1 1V\ ❑ Zoning District <br /> his project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. ❑ Permitted Use? <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER PEPTIC 13 D I c- 60 (new/existing) <br /> HEIGHT IN FEET 2 - '` NUMBER©F STORIES: (Not including basement) <br /> 7 1 1 ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: �( 1ST FLOOR: ❑ ErosionCOntrol permit <br /> d / q , TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR: 3RD filling/access) <br /> FLOOR: <br /> ESTIMATED CONSTRUCTION COST: i �[ y6�5 ❑ Review Location Survey <br /> (Please round to nearest dollar) ♦ ♦ —► ♦ `Z� 4 3-7 l and available options. <br /> J <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes EiNo [Don't know <br /> 2. Is there a wetland or floodplain on or near the property? <br /> la es ao ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? es DVVo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes pNo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# <br /> (leave blank if none) <br /> 6. Is a location survey required? (see reverse) <br /> 7. Is this to correct a violation? [Yes o !�i a on't know <br /> [Yes glislo <br /> APPLICATION MUST BE SIGNED <br /> 545112(4108) (Continue on Back) ■ -♦ <br />