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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 /> KlAci -Prrr' czZoning Status; CUP; <br /> OW RADDRESS Number,Street,City.State,Zip) �-1 Deed Restriction; CSM <br /> F•0• l x 1 l PDS �JJ 5,�-5-7 '- 0D l'l Variance(# I Of 0 <br /> HOME PHONE CELL PHONE iE-MAIL ADDRESS <br /> .' !COO b—((3 F=15o! I MSrKed�r0/ kin X0). CV^oN IA Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> cg Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City.State.Zip) Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable to nshi <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> r� [e( >K CI CV/ VOY <br /> IS Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Oral Elevation of property <br /> PARENT PARCEL NUMBER: CUR NT ZONIN ACREA <br /> ❑PARCEL COO /.- frontage drawn to scale. <br /> NUMBER -09057-101- C7dV +1 <br /> TOWNSHIP: SECTION: � ) /, <br /> ROxlx4,- ! V 1/4. �r 1/4,/4. Driveway permits <br /> AD Ess: (state,county,town) <br /> C:).9 aril(4 n id .xt u K C 1 1, W� s35-3 Sanitary permits <br /> CSM: /�� LOT i SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: = <br /> Ix't..5 id f)--1+1 a I /4 0 v1,4-- k w District <br /> istrict <br /> . <br /> This project is a new building or structure. Permitted Use? <br /> 0This project is an addition/alteration to an existing building or structure. j' <br /> SANITARY SERVICE PERMIT NUMBER: "I Rura'Address <br /> EWER EZEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Qo t—O " etialndfpkocipiai <br /> OC AREA TO NEAREST SQUARE FOOT: SiDtl <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches ' <br /> BASEMENT: 1ST FLOOR: �tonCon pi permit <br /> b s� 4o /_o g� I TOTAL SQUARE FOOTAGE: I Lzo; disturbance,- filling/access) <br /> 2ND FLOOR: 3RD FLOOR: (� <br /> 6 3 O s Revie L4 .- ■,•n Survey <br /> ESTIMATED CONSTRUCTION COST: c - ,t - - options. <br /> (Please round to nearest dollar) .$ )OCR$ . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes allo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes filNo LIDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Ries Elisio <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes IZINo <br /> G <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# to_l 05 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) OYes No Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) _ _ _ <br /> 545-112(41081 <br />