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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE e- <br /> OWNER NAME <br /> e-" 4- �� �-f) _ ►�1 Zoning Status; CUP; L <br /> OWNER ADDRESS (Number, et,City,State,Zip) Deed Restriction;CSM 7 <br /> ;r • �f : . A • .1_ 53558 .0 � ) <br /> HOME PHONE CELL PHONE E-MAIL•DDRESS <br /> ..3-7/2— : 17, b. a -,1i, • • ' . : ❑Site Plan drawn to scale <br /> - AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAM <br /> _ -•• /t'4 ' iSO`I A Mel Cccl LLC U Site Plan including locati.• <br /> AGENT ADDRES CONTRACTOR ADDRESS <br /> 0 `f 1 N6 in At (CY "717 tA)r 15 on 51 3 0/3 o/jp �-p <br /> (Ci State,Zip) (City,State,Zip Er Setbacks / <br /> C. 6'l ? (I at t r' f/ Lu.� sun Pr et%r,' e , tux 53590 <br /> PHONE(Q O g- g 3 7 - q1' (ocn , Y 3 -). 5 3 7 8 app Plan township.from //4 <br /> applicable township. �1! <br /> E-MAIL ADDRESS ,� 1 E-MAIL ADDRESS <br /> ev► •m p 0,Aa1 `er , y) ,Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> XII PARENT PARCEL NUMB/E�R: s / CURRENT ONING: ACREAGE' (�[� i Elevation of property <br /> ❑NUMBER tO /o'�V f3 ✓ ,f�' t , / (�p 3 J / frontage drawn to scale. <br /> TOWNSHIP: SECT <br /> t^ `k ,/e. ii/ 1/1/. 5 iv ❑Driveway permits <br /> 01.2 k ADDRESS: (state,county,town) <br /> Sa _ <br /> ❑Sanitary permits <br /> CSM: LOT SUBDIVISION � d (public,private) <br /> _3 / C rlL4 K, <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PR fCTRRE ':4; ON: I <br /> �(G %:x 1 N, -xq p ti 00:1 Zoning District g— <br /> . OThis project is a new building or structure. Dif Pe itted Use? r 9 <br /> This project is an addition/alteration to an existing building or structure. ] Aft 6-*. AQ c( <br /> SANITARY SERVICE: PERMIT NUMBER: Al Rural Ad <br /> EIMER PEPTIC (new - <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) / <br /> / y / A Wetland/F000dplain/ N A <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) �'ErosionControl permit <br /> BASEMENT: 1ST FLOOR: D <br /> 6212-s /, ' �Z + TOTAL SQUARE FOOTAGE: + (slopes,disturbance <br /> ■2ND FLOOR: 3RD FLOOR:` .,access J/ i <br /> ,,CT-2-11Co 0- ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: –. –. –. $ 2 5/ 0 Q 0 , 00 and available options. <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? Dies ao ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes EVo <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 alo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ao <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />