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. ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME r ^ <br /> ,��/ID D BUD Zoning Status;CUP; 2_ <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 3010n 1 rt3C-.t fll7 t /YItj►sr..l w/ 5 37►j <br /> i <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS _' ) 1, it # / <br /> l•ot say-IboD &o8 Kt/; goil) !/ /t1� <br /> ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> I-Iou5C ODqvgj -ni/fre/ A te,17Al Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> W top/ rwoR5E. Rd <br /> (City,State,Zip) (City,State,Zip) Setbacks 3 040/0o <br /> P O Y p w e r r E, wr 5 v(7 55 <br /> PHONE PHONE — IN Site Plan approval from c <br /> L.t --S-71, 3/6.3 applicable township. Fill.`_/ /_ <br /> E-MAIL ADDRESS E-MAIL ADDRESS eFloor ,y / <br /> � Our'l i R,nl e C-6,47 ,N plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) I�. // If_ / <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ,� Elevation of property <br /> PARC fronts <br /> BER EL "'' A -oZ 3g. 40' frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> eL?,:)m/4s `dr-14 6_ 3/ 1/a 1 ,/4,/a:/I, Driveway permit <br /> ADDRESS: (state,county,) <br /> 30no OW5C- J 9Q 611-02,5 6....) LI/ S 37 // <br /> CSM: LOT SUBDIVISION BLOCK/LOT ,n $- permits <br /> 13 3 5 4,,2 N /, N//1 (publi►,private) <br /> 0 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Cr— Gy+I4 E ('170/7oJ Tv NGRTh c-.► g A 2- <br /> ' ' 0 D/= ir�1571J6 NBC, <br /> Zonin District - <br /> This project is a new building or structure. Permitted Use? /j� V(0� <br /> M ®This project is an addition/alteration to an existing building or structure. a <br /> A SANITARY SERVICE: PERMIT NUMBER: Rural ,•. S <br /> r EWER r)EPTIC (ne - isting) <br /> o <br /> HEIGHT IN FEET: NUMBER OF STORIES: (N including basement) % <br /> - oreland -ttachment) / <br /> AREA TO NEAREST SQUARE FOOT: / /f <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,/(\ <br /> ErosionControl <br /> BASEMENT y 0 1ST FLOOR: permit <br /> / y 33 + TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, ,a k Sr t <br /> 0 <br /> 2ND FLOOR: 3RD FLOOR: filling/access) (,] / <br /> 3�'�i - <br /> Review Location Survey //e <br /> ESTIMATED CONSTRUCTION COST: <br /> ♦ ♦ ♦ ♦ ♦ ♦ O and available options. <br /> (Please round to nearest dollar) / O©O� 00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes EiNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYeslo EDon'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 th- •- 5 ears? [Yes EINo <br /> 5. Is this project associated with a rezone/CUP/ - .-nce(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see rev- se) QYes Jo [f]Don't know <br /> 7. Is this to correct a violation? 11 es o <br /> $ 3Y2 , ©0 <br /> APPLICATION MUST BE SIGNED <br /> 545-112 iaioel (Continue on Back) ■ —► <br />