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!ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU1OMER TO PROVIDE <br /> OWNER NAME <br /> MCilPI j 6ARegRA AUZiketi <br /> Zoning Status; CUP; <br /> OWNER ADDRESS (Nu er,Skeet,City,State,Zip) Deed Restriction;CSM <br /> (pi 66 Saw) ti111 D(\Nit ¶ kwi P1atrle WE S3cgO <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS ) �ariance(# ) <br /> (oC Y34 6uz bosses Sql% M'au,Mt • vr,axl. tvvel <br /> [4Si Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> DS. Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS . well/septic 4 s <br /> (City,State,Zip) (City,State,Zip) 0 Setbacks �����jjjjjj <br /> PHONE PHONE El Site Plana oval from <br /> applic a township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑F$r pl to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property • <br /> ❑PARCEL 21 / 11-9.3 R 1 - 8 frontage drawn to scale. <br /> TOWNSHIP. <br /> L 1 1 ' -.�ys0 <br /> EqC,TION: <br /> SItSk 01 a/ '�W4 '/a: 5W .1 —'j4'/4: IA) ❑Drivewa ermits <br /> ADDRESS: (stat ,county,town) <br /> (9 }bb Smn 14\1\ Di lit <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary <br /> °' 1I r 1-1+- r 1i6mcskt ad 5,51 . (pu� private) <br /> PROPOSED PROJECT INFORMATION AFF REVIEW <br /> PROJECT DESCRIPTION: 1 <br /> al TAA ti A �,„i,-••,a4 C tZ' x IL Shtc. El wing District <br /> his project is a new building or structure. <br /> 1ermitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 1 RUral ' • • :-S <br /> EWER OEPTIC A (new!: isting) <br /> HEIGHT IN FEET: i NUMBER OF STORIES: (Not including basement) ❑ <br /> (� I Wetiand/F plain/ <br /> Sho d (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionCon • •;rmit <br /> N A 1ca c 4, ,TOTAL SQUARE FOOTAGE: , (slopes, •'-'Urbane, <br /> \ gm • .h�ze=) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 1 dl 1'S ❑ -eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ -► ♦ ♦ ♦ � uW CP and available options. <br /> (Please round to nearest dollar) $ Li <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes J Jo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? `., ❑Yes o ❑Don't know <br /> 3. Have you talked with the township about your plR� tVyeement? :Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes o <br /> 5. Is this project associated with a rezone/CUP/variance( tition/Zap # ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) OCT ❑Yes o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> DANE COUNTY PLANNING&OEVE1. PUEW <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4i08) (Continue on Back) -4. -► -+ <br />