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ZONING PERMIT APPLICATION wwyG,L-( 9 7, _ 20 <br /> w.countyofdane.com SUPPLEMENT to Web-A pp # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME f '/ <br /> /1 c.Lc e_ Q- / ,t e <br /> A.Y ecs ❑Zoning Status; CUP. <br /> OWNER ADDRESS (Number,Street City,State,Zip) <br /> y RIc� tr c I CJ W 3358 Deed Rest ction S <br /> M <br /> Variance(# )H !PHONE CELL PHONE E-MAIL ADDRESS <br /> 33 1771 <br /> ❑Site Plan draw�scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and include imensions <br /> AGENT NAME i 3.1m-. CONTRACTOR NAME �� <br /> ^k—L/ ) 61-1/•-) c•,^S9- L,t)),, k�5 / ip.--l`('�pts ❑Site Plan inc incleing location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s406 <br /> OA <br /> (City,State,Zip) r? 5. 54-4,"01L+4,-, a- <br /> (Ciy,State,Zip) c.J ❑Set ks <br /> fl(", s — .lAt 53 /6 <br /> PHONE PHONE f ❑Site PI n a r al from <br /> .660, -_.7 Q applic b o Ip. <br /> E-MAIL ADDRESS MAIL ADDRESS <br /> (e.,.-iiI,z„)...b,e.„ c6. . 0t J ❑ Floor pl n o scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevatio of pr erty <br /> PARENT PARCEL NUMBER: CURRENT Z NING: ACREAGE: <br /> ❑PARCEL c� II++ / 0� [..J frontage r n to scale. <br /> NUMBER c�1 34I-63O7- I L7 (, 7 <br /> TO SHIP: SECTION: ❑ p <br /> .e.�5c�,- 1 , p r1 „-q 3 '/4: 'h'/a: Drivew <br /> ADDRESS: J (state, tn) <br /> ;711-13 41 e+.--- k 6 cc_.e �L(), L v-- „5-3.5.77 ❑Sa <br /> CSM: LO SUBDIVISION � •BLOCK/LOT (pui6IV, rIV te)i-ha <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION <br /> SLA.(�COr-le rs / c- /_ 00 ❑ Zoni strict <br /> This project is a new building or structure. ❑ Pe tted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Add S <br /> EWER OEPTIC (new/e . in ) <br /> HEIGHT IN FEET J ( NUMBER OF STORIES: (Not including basement) <br /> 5 LI Wetland/FIy�Qdplain/ <br /> Shor l i dV achment) <br /> AREA TO NEAREST SQUARE FOOT: 1� <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ❑ Erosion • of permit <br /> BASEMENT: 1ST FLOOR: �C1 <br /> `(p ,, TOTAL SQUARE FOOTAGE: 4 (slop: •I Ce, <br /> filiin,/a ss <br /> 2ND FLOOR: 3RD FLOOR: <br /> I <br /> r-- <br /> 1 .. 0e:cg tt;e—00 ❑ Revi ,cation Survey <br /> ESTIMATED lease r CONSTRUCTION)COST: ♦ $ 40 �, mac, an '1, - •ptions. <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? [Yes allo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes Ilo ['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 7 <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 N o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 2 N <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -* -i -+ <br />