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6 --i- . 0 7 5 t)C 6 - <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME _ <br /> Zr,xJ' f ❑Zonin• St s; CUP; <br /> OWNER ADDRESS umber,Street,City,State,Zip) Q rn i 35 Deed '- /riction; CSM/ <br /> '2°- t -f lAd So� Sf P'Y) 7A Gtr e l mac.) Varian. (# ) <br /> HOME PHONE CELL PHONE .E-MAILADDRESS <br /> (pOZS212,5ta77 (pOk Z(2- 5V77 al SriCeshopt�9P /" C.an-, LI Site Plan awn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and i es dimensiort/' <br /> AGENT NAME CONTRACTOR NAME <br /> �arba(� R o\oSc " pia J,L rr o'y 6/2. ❑ Site Plan including location <br /> AGENTAD8g1Se i,41A ASO v°1 St CONTRACTOR ADDRESS of well/septic <br /> M A 2on4 arvi 6 W I 5 35 too 14(09 3 C )20( Fr- <br /> (City,State,Zip) (City,State,Zip) ,1 ❑ Se�ack� <br /> ts 6sS - 2-1 01 Nate rocu,�-ds , (,) J S3 /7 ❑Site P om <br /> PHONE PHONE f <br /> Goo 5-15 - C pc,�-) applitaigl o nship. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> j'1 I/-in1 3 U av• 03 davc ►mo -ent- 4-es. n ei1- ❑ Floor plans ale V3 <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of prope <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL y/O06"I/02 l{-gS a,�,Q <br /> NUMBER P?- 3 Li'3 a or.tb frontage dra n scale. <br /> TOWNSHIP: SECTION: <br /> pY i rooc't0..( e- 1/4: 1/4/4: ❑ Driveway permits "-A' • <br /> ADDRESS: (state, county, n) <br /> 302—\ ❑Sanitary e5- <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, p ' te) <br /> PROPOSED PROJECT INFORMATION ' STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 5■Y13 -(r^t ■,1 re�iG.-Q.r)c ❑ 'Zoning 1 Ft.. <br /> . 'This project is a new building or structure. ❑ Permitt e Jse? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: /�.�, PERMIT NUMBER: ❑ 'R I Address <br /> [)EWER EPTIC C ', —�'�,�r ( lexisting)' <br /> HEIGHT IN FEET: ✓✓✓✓✓' NUMBER OFTORIE (Not cludinl'g basement),O,,,,,i9 V\ ❑ ,,;Wetland/F .Or • <br /> AR ATO NEAREST SQUARE FOOT: Shorelan�� ent) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ❑ ErosionCvntrot permit <br /> BASEMENT: j . (' ( _ 1 ST FLOOR 12g\ 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, a <br /> 1 (7/ �// (� fillrnglaccess) ' <br /> 2ND FLOOR: 3RD FLOOR: � i�j4//', <br /> `/ ❑ ReyieW.Loca a . rvey <br /> ESTIMATED CONSTRUCTION COST: -► -► -+ .-♦ ♦ D O and avail, • ,: ORS. <br /> (Please round to nearest dollar) t S J im <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Oyes eNa ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes Pflo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? 2 es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Oyes ZgaMo <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) Des ❑No ❑Don't know <br /> 7. Is this to correct a violation? ['Yes a4No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -0 -► <br /> 545-112(4/08) <br />