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ZONING PERMIT APPLICATION www.countyofdane.com . . . , p' " <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME `� p ØZoning�IO �' ' Status; CUP; /�OWNER ADDRESS (N mber,Street,City.State,Zip) ��1 Deed.f l6, /�.140l r/iiC (r/Oferi/� Iv/ 8, Variance s ction; CSM <br /> 1 f f49 ' ( ) I <br /> �"O4ME PHONE '1Z (LL P • ��6'1(J V 2 E-MAIL/ E/ ;zerl ir.iye -- <br /> OSite Plan drawn to scale ' <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions 4 �D <br /> AGENT NAME '/ CO TRACTOR NAME <br /> Alec C,14fJ' 4" I �i/')'C7� l 'Site Plan including location �"`� <br /> AGENT AD ESS . CONTRACTOR ADDRESS of well/septic <br /> (City,;yip) (City,State,Zip) Setbacks C3/3 ,�b <br /> PHONE , PHONE Site Plan approval from <br /> ) 8 377 (b'l) 67,-#3-9- applicable township. <br /> ILADDRES E-MAIL ADDRESS <br /> `� R <br /> IvAvA ' - 1,01 fre j ZFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.d- I : . ' /) tt <br /> PARENT PARCEL NUMBER: CURANT ZONIN ACREAGE: levation of property <br /> ElPARCEL ,y Q e ¢ frontage drawn to scale. <br /> NUMBER Q����I �C/�10� x V g F t• .t '- <br /> TOWNSHIP: SECT �`I� �� <br /> /e�„�f�',� ol'�dt/.Y �/,, <br /> %s: %%: h i% Driveway permit <br /> ADDRESS:p 00,1147 <br /> (state, COUn'� <br /> °c ii) od''re ifk ` 'i% Sanitary permits <br /> CSM: LO SUBDIVISION BLOCK/LOT .. (public } Z)6 8.5-3 � <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: r —1 ty / <br /> �"� 3( ,C L& XC ) e r If�.S ,4 Ozoning District "/ <br /> This project is a new building or structure. - <br /> ..4Permitted Use? E) i-• <br /> QThis project is an addition/alteration to an existing building or structure. k Y <br /> SANITARY SERVICE: PERMIT NUMBER: Rural <br /> EWER MEPTIC 2t� / 593-1/5- new/" <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not includin basement) t , <br /> .7, da'F/ in A,- • Ioodplain/ /I/,`// <br /> horelan 4 attachment <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ErosionControl permit <br /> BASEMENT: 1ST FLOOR:, <br /> o /c , ,1/(9)5 4, TOTAL SQUARE FOOTAGE: 4, isturbance, <br /> V (n <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> oag Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ -•► ♦ ♦ ♦ ♦ ,f and available options. <br /> (Please round to nearest dollar) $ c/�Ol,0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies Xislo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dles 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? ip es jalo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) . ank if none) <br /> 6. Is a location survey required? (see revere '� in o EJon't know <br /> 7. Is this to correct a violation? i -s o <br /> / .5-, 6 APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —P -+ <br /> S4L119!d/f\R1 <br />