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"Da-a,l/e -cee 5 ot9a.icitilic:iy-233== <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION • CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> R t Lk Q K, -,L it e j th ( ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction; CSM <br /> b 6 CZ-h.-he/411, /4v ell y 11 IA—eg-eti l)t (.J- ' Variance(# ) <br /> HOME PHONE CELL PHONE <br /> c E-MA LAODRESS <br /> ter <br /> /i 6 $-47 62.[2 '‘11 bf 69S � 7o' `A614) Q. U e-2 'sh•� �� �� <br /> 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> DcLk-) i , —b / kk. Je 0Gvne,#f " .. cz i<a' ❑ Site Plan including location <br /> AGENT ADDRESS L CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE De, pit 9. W1 5-�� PHONE pp <br /> 6 f ❑Site Plana approval from <br /> 665 9 S-62.6 z applicable township. <br /> E-MAILADDRESS clas.„1- o� r •O • ' ••-. __ e OS r Coh ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION..(http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑PARCEL o?,)z-2)/ - f o io-Z A,_( FA ± 2,s' frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> �t_ I 0" 1/4: 1/4,/4; ❑ Driveway permits <br /> ADDRESS: / (state, county, town) <br /> 10 6 Cek 1-42/ fifrtgue_ ( �t.cL 12 f,) l S 3S5 3) ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> IC l6 ' il"5'eaSo)u cuf.a potd dk (4^1 ho a)E�k Cl Zoning District <br /> . OThis project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FEVVER 1EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> l� its to < -1' 1 L,( , 5CPe<<v pd t<ae f ❑ Wetland/Floodplain/ <br /> rP G /'l Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br />. (Outside dimensions including unfinished area, attached garaisp d above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: , 1ST FLOO - 3 <br /> jD OS� a S p <br /> t TOTAL SQUARE FOOTAGE: +, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> qt3r5. 42365 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) '4. .4. "'O. "'O. "♦ -II. $ 2 l Oa 6 , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes [ o ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? Elves , No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Oyes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies ao <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 I:8No ❑Don't know <br /> 7. Is this to correct a violation? [)C]Yes ONO <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -∎ -♦ <br /> 545-112(4/08) <br />