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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> -3 , f . <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> D/4/4 lam- 4/S0/1 IAA Zoning Status;CUP; /1--/ -K' <br /> WNER A RESS (Number,Street,City,State,Zip) <br /> Deed :- '•f• CSM <br /> 6-57 1{0-n-2�!/�l/-e .57-o.54 rem zv,' l 35F9 , <br /> I. <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS , <br /> /i7-373—?,210 c8-9`/is ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION : • I c uses •`"'': ,! <br /> AGENT NAME CONTRACTOR NAME <br /> '{fil koy777'7 ❑ Site Plan includin. location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s-• '...../.111711."- ' z <br /> I3 D9 /,,ewer 57^ p <br /> (City,State,Zip) (City,State,Zip) ❑ Set•ack- 6 3 l 0 � I <br /> .moo„5 470,1 u„ ,-33-57' �0 <br /> PHONE PHONE Site Plan .•proval rom. / <br /> o - -.73-57 79 applicable township. /�/l4— <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> l�•/ <br /> i=ii Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) I►-/ Elevation of property <br /> PARENT zzgji y U B CURR TZON ACREAGE:❑ PARCEL / y 1. ,�Qd 3 T 0/ 3/� frontage drawn to scale. <br /> NUMB R <br /> •TOWNSHI . SE TIO • <br /> (i. ... k r 1%: S 140/ 141/a: I gpriveway permit kik <br /> : (state,coup Own / <br /> ADDRESS <br /> :5 0H , ev- v," // rD <br /> /51 Sanitary pe ••• s ri'el <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> _i N � (public, w <br /> PROPOSED PROJECT INFORMATION STAFF REVIE , .,, pC <br /> PROJECT DESCRIPTION: 4 <br /> 6QCk (Zoning District ,. f fi <br /> 1 <br /> ❑This project is a new building or structure. Permitted Uses 1 <br /> pThis project is an addition/alteration to an existing building or structure. Rural •e 4- �I� <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> .g <br /> ❑SEWER (n <br /> A,SEPTIC e xisng} <br /> HEIGHT IN FEET: —2 NUMBER OF STORIES: (Not including basement) , . <br /> .� W,etla of/FlebdpOin! <br /> =Shorelard att.,.`ciment' <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) -;P <br /> �E`rosionCQntrot�permit __ <br /> BASEMENT 1ST FLOOR: 2 <br /> 4, TOTAL SQUARE FOOTAGE: 4 (slopes,'IIStCirb nC€r , <br /> 111•/ <br /> 2ND FLOOR: 3RD FLOOR: �( <br /> S2 <br /> ❑ Review Location Survey, <br /> ESTIMATED CONSTRUCTION COST: $ / 2 ®DD and avc'itIBbiaoptignS <br /> (Please round to nearest dollar) <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. Is there a wetland or floodplain on or near the property? ❑Yes ViNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? AYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes No <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 r=4 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />