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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> / /el9 Y J` I ' 1 1 NCR I•4 Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> HOME PHONE " Cf CELL 3 c E-MAIL k , �l '3 5-7A Variance(# ) <br /> ,G,- - ,'7 (0fr- ^ /& Z g Site Plan drawn to scale # / <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimension4/ --CF <br /> AGENT NAME CONTRACTOR NAME -}-� <br /> 'k �, �(p � I �• , GO n SIT Cf 4 J 61V 2�,,(� Site Plan including locati n <br /> AGENT ADDRESS / CONTRACTOR ADDRESS of well/septic <br /> f .0OS "t-li - c ht+ igotet cif. S�'�`-� 7 o c` <br /> C' State,Zip) (City,State,Zip) /41 Setbacks J <br /> G7/go l <br /> PHONE tv c,& PHONE N� ASite Plan approval fr / `�,( <br /> kr(--V 7-1,975'.— q414—/9- 5 applicable township. 'V f(' <br /> E-MAILADDRESS E-MAILADDRESS <br /> ilit Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) I►� Elevation of property 2-2-1 PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: / p p y <br /> LI PARCEL MBE U&06 _' I)t 1*f,o-0 h a ,231.C' frontage drawn to scale. <br /> NU R j <br /> TOWNSHIP: Q SECTION: <br /> • Z?/ - r1 0u ' .2 7 1/a: iv ,. 141/a: 5� - <br /> gD- -way perml <br /> ADDRESS: CO County, <br /> ' s fi172 <br /> CSM: 06 LOT SUBDIVISION BLOCK/LOT o�� Sanitary •".••n <br /> • (public, i <br /> PROPOSED PROJECT INFORMATION `"''' STAFFREVIEW <br /> PROJECT DESCRIPTION: /4 n ' � <br /> N (A) /4 c u S ? .. zoning District u� <br /> t, If <br /> . 09 This project is a new building or structure. Permt ' <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 2 D R , AddreS 'a� <br /> lite,nt,.+ <br /> a <br /> ❑SEWER A SEPTIC <br /> -' <br /> HEI GHT IN FEET: NUMBER OF STORIES: (Not including basement) i 3 <br /> e' <br /> W . rootrnikta'rdf <br /> AREA TO NEAREST SQUARE FOOT: oretatl® a o ime nt " _?- <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) } 3 p <br /> BASEMENT: 1ST FLOOR: ��EXOSI;swolr rbl e[t'(tt E k 24 3 j, TOTAL SQUARE FOOTAGE: , (slopes,disturb., ce 2.� <br /> felling/apccess)Y , <br /> 2ND FLOOR: 3RD FLOOR: s <br /> —cg211:7;27974 . s <br /> Review- aca ott Survey <br /> ESTIMATED CONSTRUCTION COST: 'and available options <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ s <br /> -y3 ®oo, oD <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 ❑No Li 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 ❑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 viol. •:.i • Yes ❑No <br /> W‘ 2 ' t ©0 APPLICATION MUST BE SIGNED <br /> (� (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />