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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU OMER TO PROVIDE <br /> OWNER NAME <br /> uA.A-°` -1.3 reppr o ing Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) e d Restriction; CSM <br /> 1501 ga,l.e fiXi 1 ()2rc ■ 1(-✓1. 5' 35 '93 a lance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> tjgS3y ..10 E v- OM --3wo : bvet.,.e.ti(' ,v.a;/.cew- ie Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION a d includes dimensions <br /> AGENT NAME ' CONTRACTOR NAME <br /> 0 $QA,Q- ak S ,OtAdN2-r Site Plan including location <br /> AGENT ADDRESS CONTRAC OR ADDRESS of well/septic✓ <br /> (City,State,Zip) (City,State,Zip) S: •-cks V <br /> PHONE PHONE ❑ i - Pla pproval from <br /> pplic le township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> V loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: V p p y <br /> ❑NUMBER 0 S o'03 N'I x(00 P- - t 02,O frontage drawn to ale. <br /> TOWNSHIP: SECTION: n � <br /> 1/11L411k` SE 3 '/4: r- '//'/: I v ^ ❑ Drivewa ermits ' <br /> ADDRESS: (stat ounty - n) <br /> I SO( Rz,,..c�E I !'a, <br /> ❑Sanit. permits -r <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 1"0 V\ (• . • IC, private) <br /> PROPOSED PROJECT INFORMATION I STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 4Itertt hN^ 41, J (Vil^5i,,.., MI Zoning District <br /> . ❑This project is a new building or structure. 0� Permitted se. <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural dress <br /> FIEWER PEPTIC (new/e fisting) <br /> HEIGHT IN FEET: <br /> / NUMBER OF STORIES: (Not i uding basement) <br /> I ❑ Wetland/ oodplain/ e_ <br /> AREA TO NEAREST SQUARE FOOT: Shore nd (att ment <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: Ft ❑ ErosionC trot permit <br /> - c9 /4 4, TOTAL SQUARE FOOTAGE: 4, (slopes isturbance, <br /> 2ND FLOOR: 3RD FLOOR: I! I _�_ � filling! ccess) I <br /> 7 __...._ <br /> (�( - =idos ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ Da available options. <br /> (Please round to nearest dollar) $ - W 3 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? E4s o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes o <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# ) (leav blank if none) <br /> 6. Is a location survey required? (see reverse) es MNo ❑Don't know <br /> 7. Is this to correct a violation? es ❑No <br /> 1° APPLICATION MUST BE SIGNED <br /> (I}yI 44// (Continue on Back) <br /> 545112(4/08) Q <br /> 0 4 1 . ,,, ,c1\ 1 ∎e, p1 t f- <br />