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ZONING PERMIT APPLICATION www.countyofdane.com '.SUPPLEMENT to webAp#- <br /> :PROPERT OWNER•INFORMATION ;= ,"_ - F ` '' `_ ' ' ''4'" OFFICE USE.ONLY ; <br /> OW R NAME <br /> �„� )- i {z i,1G ( cton \2- [3:,...2c ning District <br /> OWNE ADDRESS (Number,Street,City,State,Zi <br /> "10° —Ul ae Lr Sk-ov -►t'1 LL)1 5 3 • + ❑ Per'mltted Use?•N <br /> P,I-IONE r E-MAI DDRESS <br /> AGENT; D� O Zoning"Status; CUP; <br /> `�'_`,. �', '', CONTRACTORINFORMATION k. ' `,'{'t;,rte"_., . <br /> AGENT INFORMATION Deed.Restriction; CSM , <br /> AGENT NAME • TRACTOR N ME \/arlanCer(# <br /> AGENT ADDRESS CONTRAC ORn AD'DRESS U ❑ Slte Plan draWn,to scale. <br /> .11 �t He- _ O y eilar Jec � ` and includes dimensions `- <br /> (City,State,Zip) (C'y,State,Zip) 1 _ - <br /> �p V Wly__)____‘_1 (' ' iv In4-o 1 , l,�l 535 .9 ❑ Site Plan including location <br /> p1-iONE> � ( P ONE - ^� Of well/se ptic , <br /> 1/4,r19(:)`‘ � `t 6 • M`� DRSi -1.7 <br /> 0,Setbacks <br /> JaeJhotrneSe-1eS Qk()-1)141'11 ,Co,"1 <br /> PROPERTY/LOCATION;INF,ORMATION;? (http a//aee essdane;Co dane.w7:us1)` >.';''' ❑ Site Plan approval from' <br /> PARENT PARCEL NUMBER: i n ZONING: ( ACREAGE: appI'Cable tOWnShlp <br /> Li NUM FR 1 bA0- ato g006- 3 1�f d 6 <br /> TOWNSHIP: ❑ RUaI AddreSS z)UY)r• oO Y: � UJ / /: 5 (new/exing) <br /> ADDRESS: ?! <br /> s <br /> j i 53S locrplanstosca <br /> le o .O x aK # � <br /> CSM: QkLLOT L f SUBIIVL ) <br /> ISION I BLOCK/LOT <br /> et 6 1 , �� U E1ev'ationr:of property <br /> PROPOSED'PROJECT INFORMATION , ¢ frontage drawn to"scale. <br /> PROJECT DESCRIPTION: <br /> a$1 �c 1Eo' mob►I' ,, ins la 1)1 161 £ ecx )) skps ( (' r�r w1. s p' . v Yl <br /> ' 44 tvewa Permits' <br /> . 11 This project is a new building or structure. (state, county, tovun) <br /> ❑This project is an addition/alteration to an existing building or structure. Ox Sarilta ryp errnits <br /> SANITARY SERVICE: PERMIT NUMBER: i.(pi blic,private, <br /> LA-SEWER ❑SEPTIC '. , F I c; <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) Q Wetla{�d/Floodpla'n/ <br /> 1 Z"i . S1 oreland/(attachment) <br /> AREA TO NEAREST SQUARE FOOT: �` t 1f' , <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) [] ErosionGottrolpe/mit <br /> BASEMENT: 1ST FLOOR: `` <br /> (stopes,`dlsturbapce, <br /> 1 LT) );;�'+ j, TOTAL SQUARE FOOTAGE: 4 <br /> C, ( filling/acgess) s " <br /> 2ND FLOOR: 3RD FLOOR: _ a : ti(,yc , +z- <br /> OReview Location Survey <br /> ESTIMATED CONSTRUCTION COST: $ ' �1r Ov and available options <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ 1(/ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? Li Yes fNo ❑Don't know <br /> 3. Have you talked with the township about your project? I-Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? BYes C3 No <br /> 5. This project is associated with.a rezone/CUP/variance (petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes 1-1A No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes ikNo <br /> APPLICATION MUST BE SIGNED <br /> d ‘t' (Continue on Back) --0. --o. —$ <br />