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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CU •TOMER TO PROVIDE <br /> OWNER NAME <br /> 1 4 M11225 1 NI Zgfting Status; CUP; <br /> OWNER ADDRESS (Number, ,City,State,Zip) Deed Restriction; CSM <br /> _ 477 Ii/l- NA .e4)c z P--D- O1.. -60A/ &1 S-367S--- ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 11C- 9 2-76 ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 541-IO!i gj IA.;Wers L..LC ��te Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> (City,State,Zip) ,K(C�ity,State,Zip , <br /> Zip ' etbacks <br /> 1 ,-- key i-, WE S3s�I <br /> PHONE PHONE ❑ Ite Plan appr al from <br /> bor-5--7S-5-S-e /applicable wnship. <br /> E-MAILADDRESS E-MAILADDRESS i <br /> e// , 'd Lce.j,'4(. 5 'ea4 ; I q loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: C cj Q Elevation of property <br /> ❑PARCEL (�'�\y7' l('� _� v O frontage drawn to scale. <br /> NUMBER �i �� �' C(�Q `� ,`' �_ <br /> TOWNSHIP: SECT�gN' �' <br /> ,1-141►. ;( '/4: n1 E '/4'/. S ❑ Driveway mlts <br /> ADDRESS: (state, unty, town) <br /> 411 Meartelev .c.7ci 0o'td 6,- ,0)., , L/ r �&5'7s- ['Sanitary • mits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (pU II •rivate) <br /> 52 61,1-5 43/4k5' <br /> PROPOSED PROJECT INFORMATION TAF'F REVIEW <br /> PROJECT DESCRIPTION: <br /> ACU;410 ti la 'Z fining District '" <br /> . ❑This project is a new building or structure. ermitted Use? <br /> his project is an addition/,iteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural A SS <br /> EWERPTIC 6 V /.. (new/e Stin ./ <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) / <br /> ❑ Wetland/Fl plain/ <br /> /� — U Shore! d (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> LJ_BASEMENT:0 1ST FLOOR' y <br /> ErosionContr ermit <br /> _d j TOTAL SQUARE FOOTAGE: j (slopes,fit rbance, <br /> flllinglapAess) a <br /> 2ND FLOOR: 3RD FLOOR: 6l.-O a ^' <br /> ❑ Review.Location,Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. I∎.l <br /> (Please round to nearest dollar) ♦ --4. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Oyes jt4e ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Eyes •, INo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Re-es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Eves <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) Eves ,!►o ❑Don't know <br /> 7. Is this to correct a violation? DYes NNo <br /> AP <br /> re. APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> 6-6 6 0 (Continue on Back) -4. <br />