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May 06 16 05:58p RippsWaunaDairy, Inc 608 849-4867 p.3 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OVV�VER NAME 0 /� <br /> '" / &/ DQt .L/LC_ _ L--rztr R! _ Zoning Status;CUP; <br /> OWN R DDRESS (Nu ber,Street City,Stat'eip '� Deed Restriction; CSM <br /> � ` ' \j �a . I LLA '- L ,,3 Y riance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> /6(S � <br /> 1 1 •-eV - � :7 ', ` / - ° � �� !�- �� �` .8-1- Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION a d includes dimensions <br /> AGENT NAME CONT''CTOR NAME <br /> --- `L C,0' As' r—, -1..-1 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR Al; SS ,n of well/septic <br /> (City,State,Zip) (City,St- -,Zip) ' ' �� tbacks <br /> ` <br /> PHONE PHONE Site Plan approval from <br /> ap licable township. <br /> E-MAIL ADDRESS ^ E-MAIL ADDRESS <br /> loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdants.co.dane.whus/) evation of property <br /> PARENT PARCEL UMBER: _/ CURRENT ZONING: ACREAGE: <br /> NUMBER /.�kD;fa /51 F04c T /` -7 ( fi�� frontage drawn to scale. <br /> TOWNSHIP: /// SECTION: "� -t <br /> �? /,3 ` '/a: A i '/4'A: /t i [_1 Drivew its <br /> ADDRESS: ��� (state, ( town) <br /> ark 6ke1J�! - �.aC' l�l f BLOCwLOT Sa ma <br /> CSM: LOT / SUBDIVISION] <br /> (pu•Ii•, • • ate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ,;- �4 /il `L _ , _> �`)t1 lG Z Wing District <br /> . pThis project is a new buil.Ing or structure. L{I Permitted Use ''" <br /> ,his project is an addition/alteration to an existing building or structure. )3 <br /> 1 <br /> SANITARY SERVICE: PERMIT NUMBER: 1 Ru : •dresS <br /> EWER r)EPTIC fib11 (n-f■ ..ting) <br /> HEIGHT IN FEET: &0 X- NUMBER OF STORI—t including basement) <br /> Lr) Wetland dplain/ <br /> Shore) n ttachment) <br /> AREA TO NEAREST SQUARE FOOT: �,,/ <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) U(ErosionCOntrol permit <br /> BASEMENT: —_�T FLOOR: j TOTAL SQUARE FOOTAGE: 1 (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RQFL-OO <br /> r Review n Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ --ii. —1o. --o• $ <br /> and availa a options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Eves fo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes . •o []Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ____ es U( 0 <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? <br /> s Elo <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 o ['Don't know <br /> 7. Is this to correct a violation? QYes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4. —► —► <br /> 545.112(4l08)4 <br />