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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU-TOMER TO PROVIDE <br /> OWNER NAM <br /> O NERfAD RESS (Number, re t City,State,Zip) \J C. co Z ing Status; CUP; <br /> eed Restriction; CSM <br /> ,. e.9-'7 A6 PCB r Rd bh/ ,,,,/ /Iariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL DDRESS <br /> e a3 -03' r ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> i avidd /Uad6r-Pi R4 A (i��<7RuCTiof! LL G ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> (`//S S4,a/!/ &rn� l.,/ b`f i.3" ,�Ljaq% 8,- /�a, <br /> (9ty,JState,Zip) / (City,State,Zip) ` Setbacks <br /> VV for/4, W/ 53 5?'1 Ve(soli a, W/ S359'3 <br /> PHONE PHONE ❑ ite P .n a.• •val from <br /> 6 o-�a-5- 3.5I{3 6,Qe-??_ - 35174?, p• c- . etownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> r.I�i/ • • , a -•/M ri?oe/or�� 'loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) C Elevation of property <br /> ❑PARCEL PARCEL/NUMBER: '-i CUR NTZONIt :` ' ACREAGE:/ , frontage drawn Cale. . <br /> NUMBER `: Vv9 p(1 '!I-IL) <br /> TOWNSHIP: SEC�7(O� (�1,, /� .{ <br /> ni/dike fon C�-J�CC)) ,/4. ,.J�l�.1 114,/4: ► v E_____ ❑Drivew permits <br /> ADDRESS: v (\ • (1 (st ,county,tow ) <br /> y(1 { 0 fl & �— P j//I/ ❑Sanita ermits <br /> CSM: LOT I SUBDIVISION BLOCKlLOT <br /> (pu c, private) <br /> PROPOSED PROJECT INFORMATION 1 STAFF REVIEW <br /> PROJECT DESCRIPTION: ,V".°,. <br /> S« le �-4 Cc��fiffio.1 7 2 ' isfi n fa ray - 1111 Zoning District <br /> . ❑This Project is a new building or structure. / / / "ii Permitted <br /> This project is an addition/alteration to an existing building or structure. LI SANITARY SERVICE: PERMIT NUMBER: ❑ Rural ' •dres' <br /> EWER EPTIC N (new/" 'stin• <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not inclu ing basement) <br /> LI Wetland/Flo atn/ <br /> Shorel (attachment <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionContr•��•- it <br /> Jq x A Y TOTAL SQUARE FOOTAGE: 4 (Slopes, • rbance, <br /> 2ND FLOOR: 3RD LOOR: fillip•. ° SS) , 1� <br /> 3 g � ❑ Review Location Survey: 1 <br /> ESTIMATED CONSTRUCTION COST: ' <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ o{3 .5-00 . 60 and available Options V <br /> I <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes jNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ©Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ZNo <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 ©No ❑Don't know <br /> 7. Is this to correct a violation? ['Yes No <br /> _2C6'4/ APPLICATION MUST BE SIGNED <br /> '' .-° APPLICATION <br /> on Back) -► -► -o- <br /> 545-112(4/08) i <br />