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32q <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME j 6104,4t-00 4 o , r „�� <br /> VI,(„�,Tf/ f/,��/[�/`�// � ❑Zoning Status P; <br /> OWNER ADDRESS umpb.er,Stre t,City,S e,, p}�__-. , r , Deed Res Ion; CSM <br /> 3 3 C) J karftt.� �1,� Variance(# ) <br /> HOME PHONE n CELL ONE E-MAIL ADnRE,LS�e�-- <br /> d `7 5 e9 g/ 770 51g r � � Q.-- E Site Plan �n to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRA TOR NAME_ n 3t S <br /> 5 - Si�1/�1 ,❑Site Plan i ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS a of well/s tic <br /> (City,State,Zip) (City,Ste�eC 8)55 ls ❑Se YYY kS VAI-rik(4.1.4 <br /> Vi (k1, <br /> PHONE PHONE ,.... PlAi p,,• -I from <br /> -1(° applic ID b t• ship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plan scale <br /> PROPERTY/LOCATION INFORMATION...(http://accessdane.co.dane.wi.us/) of r erty <br /> ElNI PARCE NUMBER: CURRENT ZONING: ACREAGE: <br /> NUMBER 0CIO 0 70 7-36 3-816b- 9 A`01 4 g frontage dra n to scale. <br /> TOWNSHIP: SECTION: ,/4 1 ❑ Driveway ri <br /> ADDRESS: p f�,,� <br /> 3 330 - 12 'o ___ 53593 ` ❑ Sanitary permitlA <br /> CSM: LOT / SUBDIVISION BLOCK/LOT (public, private) <br /> 5/ � <br /> PROPOSED PROJECT INFORMATION ' STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ❑ Zonin tact <br /> . ❑This project is a new building or structure. ❑ Permittq se? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEVVER EPTIC (new/ex ) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> Li i 0 <br /> ( Wetlan / . <br /> Shore chment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attaj d g8rages and above grade decks or porches) \ ❑ ErosionCOntrol Ait <br /> BASEMEN 1STF •OR: i� <br /> J� IA' !A � <br /> if `k1;. /to) T Tot, T A OTAL SQUARE FOOTAGE: j (slopes,dl <br /> 2ND FLOOR: O` V 3RD FLOOR: lb a 0 ' '� fillingfacce s) <br /> 3-a D 37w y <br /> ❑ Review c I rVe <br /> ESTIMATED CONSTRUCTION COST: Q �b and av a e ions. <br /> (Please round to nearest dollar) -* '♦ ♦ ♦ -► '—► $ 110 (0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Elves [ lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies aro ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes Eai o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Elves I o <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 EClo ❑Don't know <br /> 7. Is this to correct a violation? Elves . No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —* —i• -♦ <br /> 545-112(4108) <br />