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lfC .a <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Me/a/r,c We;`ter ❑Zoning atus. UP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Re tri ion; CSM <br /> 9y a Dunlap No//ow firs z ma n,e 047. 5--1--6-7 fa) _ Variance ) <br /> HOME PHONE 4 otj CELL PHONE E-MAIL ADDRESS <br /> 795- A x'401 Site Plan dr wn to le <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and include di ensions <br /> AGENT NAME CONTRACTOR NAME <br /> Cur Pue r- Frey Consf/'vcfion ❑Site Plan in udin ovation <br /> AGENT ADRESS CONTRACTOR ADDRESS of well/septi <br /> 530 ,•'k Ave. pi:.ir,'e. 10 Sa c So en e•_ <br /> (City,State,Zip) (City,State,Zip) ®Setbacks <br /> Pro s T/G d v ...54.e._ ' S a el c <br /> PHONE PHONE ❑Site Plan .•,�r6v .re m <br /> ‘e1? 611 3 7 9/l t Sa wr'c.0 applicabl= tow h. . <br /> E-MAILADDRESS E-MAILADDRESS <br /> CO IN Ra Cons u•• , • - Co . ❑ Floor plans Cale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of op <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> AJPARCEL 7 2 p d frontage dra scale. <br /> NUMBER OSO^OPo7'3l3' LS�V'� /T - jex y l3� g <br /> TOWN IP: SECTION: <br /> DX6ury S C 1/4: Sw %4%4: 3/-9'7 ❑(stat, o er <br /> ADDRESS: <br /> 9I//R 12un/a P 1710 Ike,' 6'a 20 ',ion,'e 64.,2" ___6-34-7 7 K El Sani p r I <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (pu c, i te) <br /> PROPOSED PROJECT INFORMATION STAFF - VIEW <br /> PROJECT DESCRIPTION: C &, f O <br /> ara G. � � —i' 24 D Zonin• ►'strict <br /> . ❑This project is a new building or structure. ❑ Permitt se? <br /> ,®This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: / /p),47,1 Rural Ad ss <br /> EWER } EPTIC V (new/e ) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> a ' ' ► V one D Wetland/FI <br /> I Shoreland tilknt) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ,, <br /> BASEMENT: 1ST FLOOR: '� D Erosion nt of • <br /> ,8o t52/1i _ .1. TOTAL SQUARE FOOTAGE: , (slopes, t f0 -, <br /> /`J filling/a <br /> 2ND FLOOR: 3RD FLOOR: gr ESTIMATED CONSTRUCTION COST: D and ay: ••- i` Urvey <br /> (Please ) ♦ ♦ ♦ ♦ ♦ ♦ $ „90,,,,00 and av •ptions. <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 ao ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Efres ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies 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 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ -► <br /> 545-112(4/08) <br />