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ZONING PERMIT APPLICATION www.countyofdane.com <br /> !:111221113:11=51:111, <br /> PROPERTY OWNER INFORMATION C STOMER TO PROVIDE <br /> OWNER NAME <br /> 5cP■4 UolP1,A ,rie Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> i �: Deed Restriction; CSM <br /> 20 l, <br /> / � (,YZ Q\ Ce ,Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> '► G''11.a' •<<M <br /> 2 , S6�O • CV 5 c Z Sr c'� , f�a‘rrh/ehraniwe.,d,i e (4177/ " AWE Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dim .ons <br /> AGENT NAME CONTRACTOR NAME <br /> % <br /> nom; PlS*C- Cl ite PI ' cluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS Joie11septic <br /> S v 4� /(c. rdy 7-6?),"/ Y�, <br /> (City,State,Zip) (City,State,Zip) tai Setbacks <br /> ( au/I✓ikee L 53,5 W <br /> PHONE NE ❑ deli Iabn l ap o wnsahl i pfr om <br /> 57,,< ?v <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> --,41-(Fjrit,G,;1e4, €)c fvt41♦.cZ A �' loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL N MBERR': CURRE,NTZONING: , ACREAGE: ...:1„.:::") Elevation of property <br /> ❑ <br /> NUMBER 07 O r ��/_ O�'C',-& K \� frontage drawn t scale. <br /> TOWNSHIP: SECTIt <br /> Tow. /I )-- Kck I"(\I � 1A. N 1/41/4. ❑ Drivewa ermits <br /> ADDRESS: (stat , county wn) <br /> 2--0 T7 Don() r I(Z. C ❑ S. ita ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (1 • , private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> No/ii� Ja [ j; . 3 oning District <br /> . ❑This project is a new building or structure. Permitt-1, • e? <br /> Phis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural/214• es <br /> R ❑SEPTIC (new/exi- 'ng) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not inclu ing basement) <br /> ^� _ CI Wetland/F odplain/ <br /> Shore! d (attac ent) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached g rages and above grade decks or porches) <br /> BASEMENT: 1STF r O // ❑ ErosionContr permit <br /> I L / I f j, TOTAL SQUARE FOOTAGE: 1 (slopes dl urbance, <br /> filling/ac ess) <br /> 2ND FL / 3RD FLOOR: <br /> 1 I(����''�I L ❑ Review Location Su y ∎_ <br /> ESTIMA ED CONSTRUCTION COST: ♦ —11. (� j Q() and available options./-6)(Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Lid'No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes lo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 21<s ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? CI Yes 01Qo <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 �1❑1�0 Li Don't know <br /> 7. Is this to correct a violation? CI --'LIJio <br /> g)) APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545-112(4/08) <br />