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4.2815.&S <br /> ZONING PERMIT APPLICATION Www.countyofdane.com .,SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> E <br /> OWNER NA <br /> OWNER <br /> N IPA'"'..c.,r a ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> G r'< L✓ C.KG.VC-iL 4, �c. /6-c. 4i,r e s �T Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 4.o f - ?2`-'G9rc Alvlf,;, -,r,,.,,."-,,, el Aa..... cc....-- ❑Site Plan drawn �s a e <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> s „ <br /> 14',c4--' f 6-....v.ne" '-) ❑Site P including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> /72/; ,,,--e/ 1/ . <br /> (City,State,Zip) -- // (City,State,Zip) ❑SetL T s <br /> PHONE PHONE ❑Site PlE j val from <br /> 61•a - S - �//t./ '" applica I t5 ship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> /air/1". e2 ,11","'"x4-- (ZeAgg.c... " ❑Floor pla s scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation o r0 rty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER O//L -//Z-994?‘• /Z/ - p 2. p frontage dr to scale. <br /> TOWNSHIP: 7c2-70 ^ C SECTION: o 774n, 2 It C 1 <br /> �c�2(+'e-/Li .e+, I 1 'A: f�Ai J 1/41/4 44,SW ❑Drivew y p rmits <br /> ADDRESS: , O ,,-� (state, nty,town) <br /> CSM: LOT �U10 12 <br /> El❑Sanitary permits <br /> zG 9 q Z (public,pr_.�ip <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / r el <br /> -■���� 1 r4^^• % ��e & /��---`-- ❑ Zoning District A..- <br /> 2This project is a new building or structure. <br /> ['This project is an addition/alteration to an existin Lildin or StTM GtU�Fe: --- ❑ Permitted ? <br /> SANITARY SERVICE: PERMIT NUMBER: ral Address <br /> EWER 1EPTIC t 3•-?0 --co /existing) <br /> HEIGHT IN FEET: F-STOFt1S: (Not in uding basement) <br /> 9 '_ C., '' MI ' / ❑ Wetland/Floodplain/ti Shoreland (attachment) <br /> AR O NEAREST SQUARE FOOT: <br /> (Outside dimensions au•ii!, 4nfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: _ 1ST FLOOR: ^ - <br /> �Z/ 7 � /G �� VI() 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> -ZN9ftO0R: C.�oaev-i£ 3RD-FL-90R: 1:-..-e--e pc•c` <br /> filling/access) <br /> 90- Z E. ❑ Review on rvey <br /> ESTIMATED CONSTRUCTION COST: ♦ -► ♦ ♦ -11. $Q -2_7.0 poi) and a b pti ns. <br /> (Please round to nearest dollar) .p / <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ao ❑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? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑X 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 Elo ❑Don't know <br /> 7. Is this to correct a violation? Eyes EJNo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ ■ -► <br />