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* 17( , 7_._5 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> O ERN E <br /> OWNER ADDR SS (Number,Street,City,s< e,3 ip) ❑Zoning Status* P; <br /> /l 7 EL ale j'AC P., m c-r S ha 1 I t IN t I Deed R s - tion; CSM <br /> HOME PHONE ` ELL PHONE E-MAIL ADDRESS vv Variance # ) <br /> ) I-,/ �r` �/ ,� Q - da g&‘b Sv be m ci I.coM 0 Site Plqn 4r.alvn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and in es dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Yv la- ‘:;l (iy 0 Site an i ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of wel tic <br /> (City,State,Zip) "70 L.,A-L'fk�t d <br /> (City,State,Zip) 0 Sq Cks <br /> PHONE i1r1A:a-0►r�v►t t I Ie-+L 5"Y (Pn VV" , <br /> PHONE ❑Site P1:n=:J . _ om <br /> 920 -311 — 1 z-35- appli'-. -7o 41,ship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plan t cale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: El Elevation f p erty <br /> El <br /> PARCEL <br /> NUMBER 0112`3/ �t frontage tQ LSl0o6ee A-1 env -39 -1 to scale. <br /> TOWNSHIP: SECTION: <br /> Me DI IQ 3(0 'V4: 1,1 '/,1/4: tki1 J D rive <br /> ADDRESS: ❑(sta U ty, own) <br /> /`/7 ge-) f\41e0I # 12cl AO MA,2s40ti i w� Y.3.5-9 if /^ ■ <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> ❑Sanita p it ��-+—� <br /> (publi , ) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> MA iii M; .514e0 30' )( t 3 LI Zonin 'strict <br /> ®This project is a new building or structure. ❑ Permi r /se? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Add�re�s.s <br /> EWER rEPTIC (newle, L► <br /> HEIGHT IN FEki ��VYY'���''^ NUMBER OF STORIES: (Not inducting basement) <br /> � JO LI Wetlan / ••••lain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shore] /!" -• ment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: r ❑ <br /> ErosionCo tr.4 pe 11 <br /> l ,, TOTAL SQUARE FOOTAGE: + (slope `i• `,: ce, <br /> 2ND FLOOR: 3RD FLOOR: filling/-:r:.- ) <br /> y OC(0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) "♦ "� ♦ ♦ "� "* 2S 00 Q o <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes -'lo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? es II o Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Wes <br /> ■ / o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes A 0 <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) Ekes Rio DDon't know <br /> 7. Is this to correct a violation? :Yes [Rio <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) <br />