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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ZA L 94).?e¢.k\RS L LC 0 Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> Z56( c 4 r 5'L Variance(# i”57 ) <br /> HOME PHONE CELL PHONE' E-MAIL ADDRESS • r ' S ibiL <br /> •';— l—'cab ' (QO at°-77�/BJwmC5 Le Pecrni-etz,b( ,Lici ,- Site'Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME NTRACTOR NAME <br /> vr4Wii� L.� i,r� tf _ wwelL. 1�1'/i(64U-40611S D Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS U of well/septic <br /> 12-64 N V Y &net 54.4 itot cz <br /> (City,State,Zip) (City,State,Zip) D Setbacks <br /> vvW NloezB (Zi 5.5S 7 Z r11-A go t3 L 5557`L <br /> PHONE PHONE D Site Plan approval from <br /> O 7i 8 tcce #5i_ 95" applicable township. <br /> E-MAIL ADDRESS / t,� f > E-MAIL ADDRESS <br /> i-etie-K/et.G�uEkt 6444.v is.bk. 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACR 'GE: D Elevation of property <br /> D NUMBER cxPaQ v5 kcicA too I-C,--i 5, 7, to frontage drawn to scale. <br /> TO SHIP: SECTION: <br /> 01L.U.. M _ l6� ,1c(4„•. Driveway permits• <br /> •ADDRESS: �""'`u j� (state,county,town) <br /> S1 fit'+{e y g� 0 Sanitary permits <br /> CSM: LOT SUBDIVIS ON BLOCK/LOT <br /> _o‘. 1 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ` x \ <br /> a\OZ Oc C..E i_l cs,A\ ,,n B Zoning Distract <br /> This proje t is a new building or structu w B Permitted Use? <br /> This project is an addition/a eration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: B Rural Address <br /> �EWER EPTIC . 13-- is 6- [fib Zzci (new/existing) <br /> HEIGHT IN FEET:l i NUMBER OF STORIES: (Not including basement) <br /> ZO!y ..-4--. B Wetland/Floodpiain/ <br /> AREA TO NEAREST SQUARE FOOT: ShorelatldattachmeM) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) B ErO3iOilCEnttrod <br /> BASEMENT: 1ST FLOOR: <br /> / (/{//i n TOTAL SQUARE FOOTAGE: (slopes,disturbance, <br /> 2ND 3�OF Oyl� filling/access)�//Q B Review Location Survey <br /> EST ATED CONSTRUCTION COST: Q and available options. <br /> (Please round to nearest dollar) ❑ ❑ ❑ ❑ M ❑ $ / �C00,00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes o QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ges o DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes Olo <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) Dyes o ['Don't know <br /> 7. Is this to correct a violation? QYes ■14 o <br /> APPLICATION MUST BE SIGNED <br /> L C ! (Continue on Back) ❑ D <br /> 545-112(4/08) <br /> /07 eit <br />