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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT!o Web.App#' <br /> FPROPERTYOWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME /� <br /> G `t' Ze llle. C,S O Zoning Status; CUP; A <br /> (VINE RADDRESS (Number,Street,City,State,Zip) <br /> 73 2r ,e I CP r r��o - �i Deed Restriction; CSM <br /> R `�UWt - 4 t Variance(# ) <br /> Hot PHONE CELL PHONE E-MAIL ADDRESS <br /> I 104357-6887 <br /> _ ,,r. ;,,- ;., , I■I Site Plan drawn to scale <br /> "AGENTINF.ORMATION' CONTRACTOR'INFORMATION':::' ' ' and includes dimensions 30 <br /> AGENT NAME CONTRACTOR NAME <br /> Le f,4- -r(A1jeif > C4-e- If -ooc--c tt35 Site P including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ell/septic <br /> ‘3,63/0 d ,11 y 2cS. A6 <br /> If Le <br /> (, .up Bute,Lip) (City,State,Zip) 4-Setback YYP0(. 6rvI LUr .3737/8 ""CC e>o/z5/D/iO <br /> PHONE PHONE Site Plan approval from A <br /> 6)0g - 222-173D applicable township. A- <br /> L-MAIL ADDRESS E-MAIL ADDRES <br /> C(u ra,+_,e Quve/<pooL c, 6om iv/ Floor plans to scale <br /> 'RRQPRRTYI40CATION`INFORMATION '''(httpa/accessdane.co.dane.xvLus/) . a <br /> PARENT PARCEL NUMBER: CURRENT ZONING: - ACREAGE: i Elevation of property <br /> PARCEL 0313/0708 —Di-II-41/67-d frontage drawn to scale. <br /> NUMBER 0313/0708 / + t C. 8147 <br /> oWNSHIP SECT O , 1/1/: Li Driveway per <br /> i DRE'S`S ( (state, county own <br /> 73 J SOWMit ('R icks !2 ir21tr(ctLeiow, 4? ' elSanita .- •• is <br /> cso LOT �7 VIVI SION (publi� <br /> 1 :S • er; n , vti :�P 0 <br /> PROPOSED-PROJECT'INFORMATION` <br /> STAFF REVIEW <br /> PROJECT DESCRIPTION: f <br /> <8`X 36 !N gd2.GO,u� t�u11 y' too `— Zoning District ���777 / <br /> This project is a new building or structure. U=' Permitted Use? <br /> LJThis project is an addition/alteration to an existing building or structure. <br /> -',ANITMY SERVICE PERMIT NUMBER: Rural _Adder ' j1 <br /> EWER rEPTIC (new/' ` ! D �lp <br /> , �.;FiT IN FEET NUMBER OF STORIES: (Not including basement) /v v. <br /> ( A Wetland/Floodplain/ 4 <br /> -- -- Shore d (attachm nt) <br /> AREA TO NEAREST SQUARE FOOT: C Vc a »J <br /> vuts!de dimensions including unfinished area, attached garages and above grade decks or porches) <br /> t�ErosionControl permit To <br /> o >tMENT. 1ST FLOOR: t I�j TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> �f 0 ' filling/access) P ' <br /> 11,4E,FL OOR: 3RD FLOOR: / , <br /> _ L� r. Review Location Survey , <br /> ESTIMATED CONSTRUCTION COST: $ S//Ql� c�° and available options. <br /> (Please round to nearest dollar) -4.- -► <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [-Yes L No EDon't know <br /> 2. Is there a wetland or floodplain on or near the property? f Yes [No nDon't know <br /> 3 Have you talked with the township about your project and are they in agreement? EYes ao <br /> 4 Has there been a zoning permit issued for this property in the past 5 years? EYes ONo 83 61614it J<,'cu) <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) rYes IMNo EDon't know <br /> 7. is this to correct a violation? , - nYes MNo <br /> ( s 'tf; G o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -r. —► —► <br />