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r■A-- I tnit/ Q ‘, V-e-frii E3-7 — 3 31 ( <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App a <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> Ma u ne-i4ct RI ve.f bctr+� L L c <br /> ONER ADDRESS (Number,Street,City,State,Zip) ( ►7 Zoning Status;CUP; <br /> W <br /> 6 r co �w,h L�rse, RC?• 5..„t )a trze, ,W! 53S4D Deed Restriction;CSM <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS Variance(# ) <br /> os-B37SYgo OS-62S--7/!7 me, e('v�,�t.�� Co <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION Site Plan drawn to o <br /> AGENT NAME and includes dimensions <br /> CONTRACTOR NAME <br /> AGENT ADDRESS '^`tee (,.--1, Site Plan including location <br /> CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) <br /> A./f t a.f �Z. <br /> (City,State,Zip) Setbacks <br /> PHONE —PHONE nai'o I/ „, [Jd I 5-795 D <br /> PHONE Site Plan approval from <br /> E-MAILADDRESS eirs 12 O- 210- yZ 7 3 applicable township. <br /> E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 7 <br /> 12 <br /> PARENT PARCEL PARCEL NUMBER: CURRENT ZONING: ACREAGE: 3 Elevation of property <br /> --2-51-1550D-1"/1550D-1"/ frontage drawn to scale. <br /> NUMBER 09/ i <br /> TOWNSHIP: )) SECTION: <br /> a 1,461 Z S %4: N 1.0 %Y.: "N]Driveway permits <br /> ADDRESS: <br /> 670 -1,....., (state,county,town) <br /> �M I,, LA Rd 5��, bra,+-,..sz:/LU 1 S'7.S t 0 <br /> LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: STAFF REVIEW <br /> 60 x Z6 Y co r4.3 f-/ 5-I{ .-.1 1 Zoning District <br /> This project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. \,, Permitted Use? <br /> SANITARY SERVICE: PERMIT NUMBER: TJ Rural Address <br /> EWER DEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> / Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ErosionControl permit <br /> 4 TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> /2 2<70 <br /> ESTIMATED CONSTRUCTION COST: — Review Location Survey <br /> (Please round to nearest dollar) -i '► $' • -► -I. 3/0` 06 and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes [No [Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres R ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Dies,eS L.o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Des o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# u' <br /> (leave blank if none) <br /> 6. Is a location survey required? (see reverse) [Yes al° [Don't know <br /> 7. Is this to correct a violation? DYeS [No <br /> APPLICATION MUST BE SIGNED <br /> 545112(4/08) (Continue on Back) -4 -♦ —r <br />