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7 ZONING PERMIT APPLICATION www.countyofdacom' '��IL"•'JJ1ai,la"."."_,.,._:al <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNERE <br /> ,1 a r IL , ,4 A "R <br /> V 4ikei— . ❑Zoning St s; CUP; <br /> OWNER ADDRESS Nu be,Street,City,State,Zip) J i Deed triction; CSM <br /> 309 O ADDRESS Ad t,✓L l t°,l c) l ( ii V tf oV1�4, (. rJ c3�93 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL I•ES <br /> ,0 3-d.)-0 _3900 aM e, S k S 6Tt05 . — �� 2Site Plan bra nn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and inclu dimensions <br /> AGENT NAME CA NTRACTOR NA E <br /> HSSOC{A. Povo 6,jrt5 $ 12 Site P n including location <br /> AGENT ADDRESS CONTRACTOR V DR SS of well/septic <br /> l Ai 7 Co Iicc.eh. S+" <br /> (City,State,Zip) (City, te, ip) � ) 7/ gSetb r s <br /> PHONE PHq�E ` O, ❑Site Pla' 1 • '•val from <br /> �OOY - o.3 3 - •761 / applica%�e •• ship. <br /> E-MAIL ADDRESS E-MAILADDRESS n <br /> lC.V� , O1escn l� i us - -i L15 ®Floor plan scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ®Elevation roperty <br /> PARENT PARCEL NUMBER: CURB TZONING: ACREAG <br /> ❑PARCEL 0607'023_tap I _0 1 I , a7 frontage d awn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION C <br /> 'r41,J�1, O j r t S L 14: /V(.J 1 4A: �C•c ,2- ❑Drivew Its <br /> ADDRE : ] <br /> (state, o nty,town) <br /> 3(370 /T� e4 VIGcc1 +YaII U L(O4)4—� Wf- 636/3 ❑Sanity rmits <br /> CSM: LOT SU',DI SI N BLOCK/LOT <br /> ®Jf' -t- (pu•�I• p i e) <br /> evl ° <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PRO{ CT DESC IPTION: I <br /> 1 e%ok- 1��+evA-61,0✓1 C(\ C -IS I Jam. AFL.le... ❑ Zoning D' ct <br /> . ❑This project is a new building or structure. (/ ❑ Permit cilJse? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Addre s <br /> [)EWER SEPTIC (new/exit <br /> HEIGHT INIE�T: '/Z ../ NUMBER OF STORIES: (Not including basement) <br /> (J J_ q I ❑ Wetland/FlpoOp1ain/ <br /> AREA TO NEAREST SQUARE FOOT: Shorelan ttachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 1-1 ErosionControl permit <br /> TOTAL SQUARE FOOTAGE: , (slopes, Isturbance, <br /> 2ND FLOOR: 3RD FLOOR: fillln / CCess) <br /> /30 31a)Ft j�e o A ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ Q O O and available options. <br /> (Please round to nearest dollar) S j I 7 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des Inslo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Des ra o 1=IDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? es • o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es 'lo <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) Ekes i r o ODon't know <br /> 7. Is this to correct a violation? Des p o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ - -4 <br /> 4K-119/4If1R1 <br />