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t <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NUN <br /> CUSTOMER TO PROVIDE <br /> f�� <br /> OWNER ADDRESS (Nuinl aF,Street ,Stale,Zip) ❑Zoning Status;CUP; <br /> 37i-13 Oa,K Il o 0 I Dr 6_0 to, c, C� �. J4- 6-�i 2.7 Deed Restriction;CSM <br /> HOME PHONE CELL PHONE E-MAI SS Variance(# ) <br /> 235-gOZ /909-5//a-7000 ». J, 2- q1-e, 1' V1y^.h 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION <br /> AGIENTNAME <br /> CONTRAC <br /> TOR� and includes dimensions <br /> AGEJ3ft. I ESS aimed D<,.-+ L []Site Plan including location <br /> CONTRACTOR ADDRESS of well/septic <br /> '3`7 y 3 ()c,kjAJooc( Or '37g3 ©etk(, 003 pr, <br /> (may State.zip) (City State,z,) ❑Setbacks <br /> L� 11-6,k'r— &foit- LJ 1 53521 Lo c t by, r e (..ox 5 35 z-7 <br /> PHONE <br /> PHONE ❑Site Plan approval <br /> &Oa. Z 3 S -c�C) 2 1,0P--Z�S—g©Zc1 applicable township. <br /> frortl <br /> E-MALADptE 9 E-A1M_ SS <br /> `�":L GL�f�`+�• 0,e. ice, ce,TZ i , Ice,, n el- El Floor plans to scale <br /> PROPERTY LOCATION INFORMATION (http: .accessdane.co.dane.wi.us') <br /> OPARENT PARCEL MAR: CURRENTZONING: ACREAGE: 0 Elevation of property <br /> 0 ,471)• Z.Oy - 537g--Z. A . ( ,dal 7 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> ADDS V (state,county,town) <br /> 37 K 3 QajS,,j0,4 0, <br /> cswt LOT 9 SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> SUBDIVISION <br /> 86 . c., (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECTDESt rlOrt STAFF REVIEW <br /> 5 h ❑ Zoning District <br /> - I is project is a new building or structure. <br /> project is all addition/alteration to an existing building or structure. El Perrni Use? <br /> SAN TARY SERVICE: PERMIT NICER: ❑ Rural Address <br /> nEwER ( exne ( / ) <br /> HEIGHT N FED. NICER OF STORES: (Not including basement) <br /> ii`6 I ❑ wetland/Floodplain / <br /> (Outside AREA TO NEAREST SQUARE FOOT: <br /> (attachment) <br /> Including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: <br /> 1ST FLOOR: ❑ ErosionControl permit <br /> 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> Zf D FLOOR 3RD FLOOR filing/access) <br /> Z,/C. ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST ♦ ♦ -► ♦ -i ♦ , <br /> (Please round to nearest dollar) Z� and available`options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies Elisio [on't know <br /> 2. Is there a wetland or floodplain on or near the property? [yes g.4 1on't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ fres I . <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? <br /> Wes ao <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# 3 15-7-1-; (leave blank if none) <br /> 6. Is a location survey required? (see reverse) aes [) o Epon't know <br /> 7. Is this to correct a violation? Qv [ <br /> [Yes L�l�o - <br /> BE <br /> 'C SIGNED <br /> . _ <br /> APPUCATION NUST SIGNED <br /> 545-112 WOG) <br /> _ (Cattbme on Back) -► -, <br />