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ZON; . G PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> cD etetA ' _ ❑Zoning Status; CUP; <br /> 'VNER ADDRESS (Nu ber,Street,Ci State,Zip) „ Deed Restriction; CSM <br /> 7263 )idui_ d„ f'At e%eirerti idr ZS"356, Variance(# ) . <br /> • HOME PHONE CELL PHONE E-MAIL ADDREISS <br /> 6M-67 -36ve. 609-336=Az75- Ai ) ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT ME CONTRACTOR NAME <br /> ,P ,I� , e ,Q e _ ❑ Site Plan including location <br /> AGENT ADDRES. ,-3-9. CONTRALTO DDRESS of well/septic <br /> I.8 9'f 1,2469R4 axG e J D,al,- * 932220 <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> 408-A,.-5--S-3 7 1 14A(A L j LP L u."35=43 <br /> PHONE PHONE ❑ Site Plan approval from <br /> 6196•--A23'.3-371 6 c g -84' -97Dd applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS • <br /> Aeke '.) GleDt m i ng 'COrr) rac CP'i ea 3Ni/0) <br /> I i,cot" ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING; ACREAGE: <br /> ❑PARCEL ,0,05.2(3 go°off ri , A.'h✓x , frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> �� / i 1/4: A l '/a'/4: a 1 ❑ Driveway permits <br /> ADDfirESS: (state, county,town) <br /> b/S 7 c I° p..., Ge/ .S3 cr acl ❑Sanitary permits <br /> CSM: / LO /f SUBDIVISION /v BLOCK/LOT� <br /> J1.►1�wV/%�� (public, private) <br /> PROPOSED PROJECT INFORMATIONSTAF:F REVIEW <br /> PROJECT DESCRIPTION: <br /> ,i,_f1" 5il°T.4 ❑ Zoning District <br /> . Ii his 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: 1✓A PERMIT NUMBER: ❑ Rural Address. <br /> E)EWER E)EPTIC (new/existing) ;'' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 2 3' 1y,," P-zer-A, ono ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionGontro!pefmlt <br /> ra/ j TOTAL SQUARE FOOTAGE: j (stapes,dissturbance, <br /> filling/acces) <br /> 2ND FLOOR: 3RD FLOOR: 4 .- :r - <br /> l)41c.(� N41Gli 6/ 0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ p� and available options. - <br /> (Please round to nearest dollar) $.38, .,5-f7�, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes MIK; ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Wes lo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Eles QNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes [I No <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) Dies ilo ❑Don't know <br /> 7. Is this to correct a violation? Oyes pp() <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► <br /> 545-112(4/08) <br />