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T, <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME r <br /> alto#ate rake' AL e <br /> 0 Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> MYO BF.tas� Deed Restriction; CSM <br /> Tarok cr-a-4 kk 53516 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> q/4144,/45-9 4 W Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> WAfantini/Uo2 5. 03 e4'r2 1.4 ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) <br /> Setbacks <br /> /11Z1.14.44(444.4.tk)x ,—,,2,o q <br /> PHONE PHONE ❑Site Plan approval from <br /> `//4/ —26 Y--55-o l/ applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 5V44v f ,, 3:7 N4‘"et•-T2•C.-011‘ ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wl.us/) <br /> PARENT PARCEL UMBER: CURRENT ZONING: ACREAGE: ®Elevation of property <br /> Al NUMBER o Y4 OG/!•093 dfi`V�S-,3 e--/ frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> VJ L k'k- N./oAJsJr SJ°Rgru 1/4: /4/4: ❑Driveway permits <br /> ADDRESS: (state,county, town) <br /> rn 3' el9G1 cz, h At <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Ti°srarr.i. 4149,%4yL ofir4sAt.4. Y>r.e a,✓ �c '*tic 4r-k L Li Zoning District <br /> ❑This project is a new building or structure. <br /> Li Permitted Use? <br /> 'this project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEWER [EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> LI Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: r-, ErosionControl permit <br /> j TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 0.0 <br /> LI Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ COO <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes EINo aon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes Flo aon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? gYes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes I=INo <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) Efres Erlo &Don't know <br /> 7. Is this to correct a violation? ❑Yes [ Vo <br /> L APPLICATION MUST BE SIGNED <br /> 545-112(8/09) 1 � v (Continue on Back) —► -♦ <br /> c G <br />