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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNED NAME <br /> v\ I MCCJ� Status;CUP; <br /> a ER ADDRESS (Ntxnber, c�iry.sr LP) �, I 1 Deed Restriction;CSM <br /> V 1i// Wild 6w`er �G/ � clA l 01' S 3 S 8 f Vana ce(# ) <br /> /H2O,�ME E CELL PHONE E-MAIL ADDRESS <br /> 6"0 75'7 w 0137 a Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> A sk NAME , I CIO' <br /> i _ I riM .: .f! .,ti ivt"S • 11I g i i EBitteKan including location <br /> AG NT•I'-- c CTOR•...E of well/septic <br /> 3/ is.- MEM'3+/)0 si. L <br /> �" ,State. ( state.Zip) [ �etbad(s <br /> P � w,r s 358, � 4 ,, to; cis$5 v <br /> P eo ^ 1 o .66- /PHONE /08 `0^Sr/St/ ❑ap Ian proval from <br /> d'c V dV V a II township. <br /> E-MAIL ADDRESS ■ E-MAIL ADDRESS <br /> " ' Ai' VI" 7 , s 1'w44'1 ) ri pr. ' Nia,xec , gyeiplans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usi) <br /> PARENT PARC UMBER: URR ZONING: ACREAGE: Q al Ele - ion of property 61 <br /> 0 NPl MCER ovc 04 II-171--37) 1 is o - . G 90 • •ge drawn to scalt3.,'� <br /> TO P: f SECTION: <br /> $0. — S prt rt 5 +/.: + + ❑Dri rmits 7 <br /> J� ���4. <br /> /ADDRESS: <br /> / = CO■ ty,town) <br /> W/.. 4)I lei g,li.c r , Slb-1� lan �-//� 6358" 0 San ,•s •ermits <br /> CSM: LOT SUBDIVISION mock/LOT <br /> (pus, vate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIIT101.4 jç4 /�wl aval o e'1 sti ll Qn -( • . 424ing District <br /> [iThis project is a new building or structure. <br /> gy(rmitted Use? <br /> [This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: R R r. Address <br /> EWER PEPTIC ' AI, '• <br /> HEIGHT IN FEET: • NUMBER OF STORIES: (Not induding basement) <br /> v ❑ Welk: .r ..,. am / <br /> ARE NEAREST SQUARE FOOT: Shore)• • -ttachment) <br /> (Outside dimensions including unfinished area,attached gara.- and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ EfOSI• Ontr• rmit <br /> � I- x a 0 u/ I• TOTAL SQUARE FOOTAGE: j (slopes, •, • •ante, <br /> I1 �/ �l filling/. •. <br /> 2ND FLOOR: 3RD FLOOR: - <br /> ❑ Re " • n Survey <br /> ESTI D CONSTRUCTION COST: ♦ _ -i ♦ Q and ava" ptions. <br /> (Please round to nearest dollar) $ $SQO , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes Cato EiDon't kno <br /> 2. Is there a wetland or floodplain on or near the property? [Yes o 00on't know <br /> 3. Have you talked with the township about your project and are they in agreement? 2Yes Vo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ao <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 Bo [on't know <br /> 7. Is this to correct a violation? [Yes o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4105) <br /> (Continue on Back) -► -o• -4. <br />