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ZONING PERMIT APPLICATION www.countyofdane.conl SUPPLEMENT toWeb•App# <br /> PROPERTY OWNER INFORMATION - CUSTOMER TO PROVIDE <br /> OWNER NAME �1-, Wt ,Q I oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City, e,zip) p Deed Restriction; CSM <br /> S �- -Q G-,\QL,'l4oiS2 R.• t n c Variance(# ) <br /> HOME PHONE CEtt PHONE E AIL ADDRESS <br /> Sy V 1 e Plan drawn to scale <br /> 'AGENT,INFORMATION : . CONTRACTOR_INFORMATION _ and includes dimensions <br /> AGENT NAME C�j RA TOR NAME <br /> RegtET �. �Pf$e� ZCLA COA 5 T7 ey/OAl ❑Sit including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of a eptic <br /> 6363 OS ietvy /2 5,74g- <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> C!>RvNR --- ' w/ 535t1 7 / <br /> PHONE , PHONE i j. ite Plan approval from <br /> 605' 5/6 sr-Sg'o applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> arena/49,-s- ' Q At W' .COv oor plans to scale <br /> PROPERTY/LOCATION,'If1FORM!4TION,':(http://accessdane.co.dane.wi.us/)_' vation of property <br /> PARENT PARCEL NUMBER: CU ENTZON NG: ACREAGE: L}J p p y <br /> ❑NUMBER Ot oc -4-1 I 0014 0 I -- ✓✓ffrontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> S4. ,/4: %IA: ❑ Dr a ermits <br /> ADDRESS: ( unty, town) <br /> S3.0 , I,.k 141.11 Z< c- <br /> ❑San -■ • rmits <br /> CSM: LIT SUBDI SIGN BLOCK/LOT <br /> i (p•• Ic, • ivate) <br /> PROPOSED PROJECT INFORMATION STAFF EVI;EW <br /> PROJECT DESCRIPTION: ^ <br /> 17�/ ( � J )��' p 3 ��9„� nin District <br /> ['This project is a new building or structure. <br /> ❑This project is an addition/alteration to ermlttedUse� <br /> p ) t an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: RUral Addre ss <br /> . 45<kEWER EPTIC 1\/ (new o ,in, <br /> HEIGHT IN FEET ,` 4 / <br /> NUMBER qF DRIES: (Not including basement) <br /> }` w nd Qdplain/ <br /> Sh a d (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or <br /> - porches) <br /> . E C osi u p <br /> ermBASEMENT 1ST FLOOR: lt <br /> ,r14 35 _ J Li & 4, TOTAL SQUARE FOOTAGE 4, .� Slo btsturbance,� <br /> 2ND FLOOR: 3RD FLOOR: / / )I)t" aC eSS� ' L '} <br /> R0 L0.k n Survey' <br /> ESTIMATED CONSTRUCTION)COST: ♦ ♦ ♦ ♦ ♦ $ and )e-Opt)onS <br /> Please round to nearest dollar -7 - <br /> • vii-q <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? II es No • ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? I I es ulNo ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 111 es o . <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank none) <br /> 6. Is a location survey required? (see reverse) Elves ■ I• ['Don't know <br /> 7. Is this to correct a violation? [Yes j o <br /> APPLICATION M T BE SIGNED <br /> 545-112(4108) <br /> (Continue on Back) -* -* -► <br />