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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PRO IDE <br /> OWNER NAME <br /> Robe-r't —Sp 1..r\s,n l�4''y . . c., -ra.-Y ❑Zoning Sta ; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed triction; CSM <br /> -35P-3 Co,-t get, 76 ,61.E 107,,,„A 1 s Lv/ 53 5/7 Var. nce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608- 137- 5346/ Sit Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION a includes dimensions <br /> AGENT NAME e,S s C CONTRACTOR NAME <br /> 7G D. v=-1 opme,n-t- Sc ,1 , 0� 1or1 , Sit Ian including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS o ell/septic <br /> `-/v 7U E �'sr.:ryc,q,,, R,Q 1) <br /> (City,State,Zip) (City,State,Zip) ❑ etbackS <br /> El,- /17o;,AJs LJl 5'35/7 <br /> PHONE PHONE <br /> Sit: 'Ian a val from <br /> 60F _4,37 -6/gr a,•.I. a township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jcsSc Ca J dde�0.-lcym..-^f: co iv. LI or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P p y <br /> ❑PARCEL ` 3g-.F8' frontage drawn to scale. <br /> NUMBER C)GG�l07G�(o� 13-$Q7l-� RH <br /> TOWNSHIP: SECTION: <br /> Vet-✓ne'›f0- (`7- Y4: NE 1/414: St)," ❑ Drivewa rmits <br /> ADDRESS: (sta ,county,town) <br /> 3 5 a3 Co.:,.-ty Kip "SC, 131ve /40,_,,i Js (4)) 535/7 <br /> CSM: LOT SUBDIVISION BLOCK/LOT [11 Sanita rmits <br /> (p c,private) <br /> PROPOSED PROJECT INFORMATION AFF REVIEW <br /> PROJECT DESCRIPTION: <br /> MOdrYX-.>rn Add'7,of-N Lifted g District <br /> ❑This project is a new building or structure. Use'? <br /> r1-his project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMB e. ❑ Rural ress <br /> EWER I7EPTIC (new/ex Ling <br /> HEIGHT IN FEET: { ( NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/FI lain/ <br /> AREA TO NEAREST SQUARE FOOT: Shore) (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ ErosionControl mit <br /> BASEMENT 1ST FLOOR: i©rte v <br /> 4, TOTAL SQUARE FOOTAGE: , (slopes,dl ante, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/ ss) <br /> 0' <br /> LI Review Location Survey No <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) ♦ ♦ '-� ♦ ♦ /g', Q )d and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? nYes o f Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [7Yes No (Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? [Yes IZNo <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 No ['Don't know <br /> 7. Is this to correct a violation? 4. Fl Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> q <br /> (Continue on Back) <br /> 545-112(8/09) • <br />