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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME n <br /> Deecce 0 ROJ Q Act GUN CI i .�n C ,02, Zoning Status; CUP; g" F-1 <br /> OWNER ADDRESS Number,Street,City,State,Zip) Deed Restriction; CSM 1% <br /> L/37 of oot Qt Ac Gvn C I tab_ R01. Variance(# �! <br /> HOK E PHONE CELL PHONE E-MAIL ADDRESS <br /> 60% 76 - Ci A Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions i it <br /> AGENT NAME ) . CONTRACTOR NAME <br /> / i3ow� o A. � <br /> Sieve C_trmS oh [l Site Plan including locati �l4/' <br /> AGENT ADDRESS CONTRACTOR ADDR SS of well/septic <br /> 19 S Ceti Rtl an o <br /> (City,State,Zip) c- G (City,State,Zip) Setbacks ,, )/30 _ <br /> marSLc4( wr s.3. I Pi/Y1 �/0 �� <br /> PHO E PHONE S p .t4.ite Plan approval from <br /> Q 3 zf 7°S6 6�/ A61 Tr applicable township. 4/74_. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> S j c i! , Q;I i co,n ki-Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property �I h <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ,/2 <br /> PARCEL L c \p frontage drawn to scale. <br /> NUMBER • 7 0-11I-40),`91701-0 '4 RC' 1 y0. SOi-\ <br /> TO SHIP: SECTION: <br /> etk;e Id /o-7.i15w ,1/4: AN, /Y '/7/ 11 It Driveway permit <br /> (state, county, 0) <br /> ADD ESS: n <br /> 43 )(II Rod &-r ( Lb Kc [ Sanita <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (pubf , private <br /> PROPOSED PROJECT INFORMATION STAFF REVI <br /> PROJECT DESCRIPTION: r' ' / <br /> --"rjn J 0 S j !A S S L?Ile Ls Zoning f ist)ict <br /> . Mk his project is a new building or structure. a ��� <br /> ,� Ilse? / � ' <br /> /This project is an addition/alteration to an existing building or structure. k.001- '''''''5‘ S j�e <br /> SANITARY SERVICE: PERMIT NUMBER: a Rural ' ••__- <br /> EWER r)EPTIC e (ne -xistin• <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) � i / <br /> Wetland/Floodplain/ <br /> ld Shoreland (attachment) ,. ft <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST PL-BAR. S 40--- ErosionControi permit f- <br /> 3 3 4, TOTAL SQUARE FOOTAGE: 4, .(slopes,disturbance, 0 <br /> 2ND FLOOR: 9RBTt68Ra KGI S I filing/access) f <br /> r <br /> —7 <br /> 363- /o) o -- *Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ [�� of QU and available options. /M/�} <br /> (Please round to nearest dollar) .. ,`� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes [ejo Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes NIC Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? s No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Ellcs EJNo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if one) <br /> 6. Is a location survey required? (see reverse) DYes Ply []Don't know <br /> 7. Is this to correct a violation? DYes lo <br /> Per Ru SS V�- APPLICATION MUST BE SIGNED 45 So V S Q ' U 7 S P� sc. (Continue on Back) ■ -♦ -. <br /> 545-112(4/08) ,7`C\ <br />