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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ,. i f "�'.y V\0 Olt Zoning Status; CUP; <br /> /ER ADDRESS (Number,Street,City State,Zip) Deed Restriction; CSM <br /> i Wynn wood d r-. verov+a WI: 535'13 Variance(# ) <br /> HOME PHONE C LL PtiONE E-MAILADDRESS <br /> b 6 6 (o i -3064 1 O) 33y-037(e 3-1' 4 Ott ►MOIL •(-4Y'\ Ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> DPE . ri PrsOl IASS Eli C 0(net ktofhes 1 ite Plan including location <br /> AGENT ADDISESS CONTRACTOR ADDRESS Of w /septic <br /> P,o . g0 ( '5-1-0 0 49.D 50. 19- tO <br /> (dty,State,Zip) (City,State,Zip) Setbacks <br /> / vv .Jr Son W-T 5334'4 rM ad+sb o , W1 , 533'y4 <br /> P ONE r� PHONE <br /> El Site P n a royal from <br /> Cal) 5( _I 1S4 c,,0 ) /33 — Ti 3---1" app• etownship. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> 0 V e a) •(t1 - ,(o►\ i ue-0 - - ( A p -5 CO Al oo plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) E a Ion of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> ❑PARCEL Q�/oin�f_2i2-z-134--0 K_l Pr ` , 5:7-C- rontage drawn to scale. <br /> NUMBER ( �D J <br /> TOWNSHIP: SECTION: <br /> Iveway permits <br /> Town cA Scf) o5� _1c\. /a: H W /a/a: i� (state, ay permits <br /> e, ow <br /> ADDRESS: <br /> SQf ' c)c gi 0350(Y) anitary permits ,1 <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> l-1 i A-u�u m n Co • (public, private) ��P <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ��,�-' <br /> N wJ o n�I e c w % 1 h orAe �Id'Zoning District <br /> y <br /> This project is a new building or structure. ermitted Use? <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: /� ❑ 'R I AddreSS <br /> EWER t/ EPTIC ) 3-�i G- V 0 y - - n , isting)- "" <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> �v ❑ , ••/Floodplain/ :.._ <br /> AREA TO NEAREST SQUARE FOOT: Shorelan• ttachmentW <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) Eve— <br /> BASEMENT 1ST Fl 00R: rosionControl permit• <br /> TOTAL SQUARE FOOTAGE: (Slopes,disturbance, C <br /> 2 '6' 5q �=1 g Z s� 1, j fininglacc'ess) <br /> 2ND FLOOR: 3RD FLOOR: rl <br /> Zy (0c1 �— C0-4,-.' <br /> 1`YReview Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available" 'ons. <br /> (Please round to nearest dollar) "+ "■ ♦ ♦ -0 <br /> _ K- \.Ye <br /> 1. The property is within 300 feet of a stream •r 100' -- rom a pond or lake? s ❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Elves ao ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? j ces ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies 12/No <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) Dies ❑No D6on't know <br /> 7. Is this to correct a violation? Eyes DI GO <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -0 -r -0 <br /> 545-112(4/08) <br />