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. .._,,....., <br /> 7.) 0 ,. i u <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME '/}� / <br /> ' tk_ c Ktic rc (41'f n Zoning Status; CUP; (("'JS <br /> OWNER ADDRESS (Number Street.City,State,Zip) Deed Restriction; CSM <br /> ,9, 110 iI�y 11) (j r ppi<11 kv IA) j variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6a t Lis-05 ., 1,0-ii-err 6,rL ' /"io-1,c. .- ❑Site P nd wntoscale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and in es dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> /11(,--)4 /LJ n Site PI n in ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well tic <br /> y ti uL.) / L/ <br /> (City,State,Zip) (City.State.Zip) n Setlp .pks <br /> L- ro bVC L∎ 1-. (-)) V <br /> PHONE PHONE ❑ Site NN�.1.•roval from <br /> />, yv1;- (J 5 ' applZa I.�township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS I <br /> 4 a w LU✓L Fef 44,,71c, 0 0:I,(ivy ❑ Floor plaltter<ale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) n Elevatio of operty <br /> PARENT PARCEL NUMBER: CURB T ONI ACREAGE: o7 <br /> ❑PARCEL ! frontage wn to scale. <br /> NUMBER C� 5 1 -�9 LI- SUa(� - O 7. <br /> TOWNSHIP SECTION: <br /> J Ain ,/4: ,„„A: n Drivewa pe Its <br /> ADDRESS '' 0 r j 9-�� r.,c,1 <br /> (state, c y,town) <br /> CSM LOT It SUBDIVIS nnll- BLOCK/LOT ❑ Sani ry rmits <br /> ,') (publi rivate) <br /> PROPOSED PROJECT INFORMATION STAFF R VIEW <br /> PROJECT DESCRIPTION: <br /> ii/ ' l)t 9 ek /1-61-,t) /4 0 YY/ ,Q ❑ Zoning ' trict <br /> its project is a new building or structure. <br /> ❑ Permit�Use? <br /> ]This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE. PERMIT NUMBER, r(,� ❑ Rural Address <br /> SEWER SEPTIC l i (,./ 'c'c5C2 v�/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 11 i ❑ Wetla / I���/ <br /> Shor a at chment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) �� <br /> BASEMENT 1ST FLOOR I ❑ ErosionControl permit Ca(5- <br /> L glr/” TOTAL SQUARE FOOTAGE: 4, (slopes, disturbance, <br /> filling/access) 6 <br /> 2ND FLOOR: C-/ 3RD FLOOR: � <br /> LI c( ((-).' <br /> (- ❑ Review�oca n Survey <br /> ESTIMATED CONSTRUCTION COST: • ♦ --I. — _, $ ) and availk�Te 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? ❑Yes Llo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Peso ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? caps ]No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ]Yes j <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 ao ❑Don't know <br /> 7. Is this to correct a violation? ]Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -* -+ -* <br /> 545-112(4/08) <br />