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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App N <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER' NAME <br /> C �1�} <br /> 1 R u `k 4 ` A Akt-J u <br /> N 14'p r e k 4 a Zoning Status; CUP; A /4 <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> r ■eed Restriction; CSM <br /> 110? 4' A6o L#4 QEER ''(V4 WY .siccar Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> �94f ir 3 91--S rr S kN ' , v ' • 1'''< c7 - �prd Site Plan drawn to scale �/ <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions ye-c_ <br /> AGENT NAME CONTRACTOR NAME <br /> �� <br /> I- Site Plan including location Q, <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic j. <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> 63730% <br /> PHONE PHONE t3)%eeelij/ <br /> Site Plan approval from_ f/r <br /> applicable township. f <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> /tea Floor plans to scale /7 <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wl.us/) Elevation of <br /> PARENT PnE,ft\UNI i, c,f �• f` CURRENT ZONING: ACREAGE: frontage drawn to property le / <br /> PARCEL 1 �C SS T�0 t0 <br /> TOWNSHIP:UMBER 0 7 11- 3 ^ ! 1 foC1 11 cr <br /> SECTION: 5E y' s,44 £x� '4310 FT <br /> o'f -1-,t( ,14.E ,/41/: Driveway permit <br /> ADDRESS: .p (state,county, Cr <br /> /9'09 "Ljt 1"'0L_ W{ CS(5 4c3 ) anitary .- ....s <br /> 0 ,N It( 3 LOT sU, 1 ,e /_0 A<K e g (public, �1 <br /> PROPOSED PROJECT INFORMATION 11� �P� STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> �� •i1J 42.0441111 •` ' ✓YQ/yNl� iiyll 7 [fitt <br /> This s F6"ect is a ne building r structure. 't Ci� -..e- S �`'— <br /> p ) g "` Permitted Use? <br /> QThis project is an addition/alteration to an existing building or structure. 5 <br /> SANITARY SERVICE: �o PERMIT NUMBER: .l real <br /> FIEWER EPTIC +�..." (new,' <61 +i <br /> HEIGHT IN FEET: i ,L NUMBER OF STORIES: (Not including basement) <br /> .,�;rte ;, • achment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> mst©nC� nnn / <br /> BASEMENT: 1ST FLOOR: / <br /> Al 4 TOTAL SQUARE FOOTAGE: 4 fit *diStillbance, r'', <br /> 2ND FLOOR: 3RDFLVOOR:,� <br /> I- O WV XPLfteview Location Survey Al` <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) � -'� --, $ ' OOD <br /> and a able ions. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes 11 ElDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Rises E3Vo Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 1114s ON <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes [Ello <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) QYes C,�VO DDon't know <br /> L <br /> 7. Is this to correct a violation? QYes k`1O <br /> APPLICATION MUST BE SIGNED <br /> 54S-112(4/08) R F t;F I V F n (Continue on Back) . ■ —► <br />