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ZONING PERMIT APPLICATION uuww.countyofdane.c0111 ;SUPPLEMENT to Web�App# <br /> PROPERTY'OWNER INFORMATION ;' „ S_ , _ r ;. __.` f';" CUSTOMER TO PROVIDE <br /> OWNEFjiIQ)l7Ql$ Al <br /> /��� l /4 .� — _Q Zoning Status; CUP; <br /> OWNER ADORES*. S e• •ty,State,Zip) <br /> ❑ 9 . <br /> i Deed Restriction; CSM <br /> T <br /> y / ,' i G� y -S`�5�/ Variance(# ) <br /> HOME PHONE CELL PH o e E-MA.t A/DD:E S <br /> g3/- 6._er .e. .,i- ,( i ❑ Site Plan drawn to scale <br /> =AGENT IINFORMATION <br /> ,. ,._,3 COhITRACTOR.INFORM4T10NT • „- _°n . and includes dimensions <br /> AGENT NAM CON RACTOR NAME <br /> / Site Plan l uding location <br /> AGENTADDRESS <br /> (z.1a::9c4/ i3 <br /> R DsJ ofwell/se well/septic <br /> �'y�I/ & 4SLy Ct <br /> (City,State,Zip) (City State,zip) // ) ❑ Setbacks <br /> PHONE PHON / ❑Site Plan approval from�'�74—1J09 0 applicable township. <br /> E-MAILADDRESS E-MAILADDRESS . <br /> iiJlr@ e '/.emu- ❑ Floor plans to scale <br /> PROPERTY/LOCATION;INFORIOATION :-(httpe//aceessdane co,dane.vin.us/)`_ ❑ Elevation of property <br /> PARENT PARCEL NU ER. 1 CUR ENTZ ING: f ACREAGE: <br /> O NUMBER Og 6 �a�, ,vet 1 ? . frontage drawn to scale. <br /> TOWNSHIP: SECT <br /> ,/4,S 1A) ,/4,/4. (°F ❑ Driveway permits <br /> 4:oesrit7f;2/-eo <br /> / ) (state, county, town) <br /> s' 'q/ /t / ' - �'�°417 Cam/' s i S9 2 ❑Sanitary permits <br /> CSM: L. / SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION . - = STAFF`REVIEW <br /> PROJECT.f S IPTION: , <br /> 4--a--Fe 77' , d P Zoning District 2 a: <br /> his projesct iew building or structure. i <br /> 40 1?ermltted lJse'� �` } <br /> This project is an addition/alteration to an existing building or structure. <br /> . -r,FYt1., E= <br /> Q Rural Address <br /> SANITARY SERVICE: PERMIT NUMBER: - <br /> EWER [EPTIC 4111ew�exisbpg-)r. 5 <br /> HEIGHT IN FEET NUMBER OF TORIES (Not including basement) , 3 t� -' <br /> Q0Wetla dfRoast Iainf <br /> 1/ . . �. k�j = Sf oreia d_ -attachment) <br /> AREA TO NEAREST SQUARE FOOT u �-' 4 W ' �.. <br /> (Outside dimensions including unfinished area eta. -• •- ages and above grade decks or porches) j <br /> BASEMENT: 1ST FLOOR: ���•�' Erosioncontralpermit, <br /> Msfops t rbanee l TOTAL S.UARE FOOTAGE j <br /> 2ND FLOOR: 3RD FLOOR: `� <br /> r; <br /> / . — - LI Review Location,Surve <br /> ESTIMATED CONSTRUCTION COST - <br /> —i ' ' —► —r —► .* 3, 000' cb - t and —,..,, ,,P,_,t©rls, ps <br /> (Please round to nearest dollar) j -N 4_ :'� __ t.a, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes No • ❑Don't.know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes Ec No _❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? glYes ❑No .?. <br /> 4. Has.there been a zoning permit issued for this property in the past 5 years? pi es ONO . <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 j2No ❑Don't know <br /> 7. Is this to correct a violation? Eyes o <br /> APPLICATION MUST BE SIGNED <br /> 545-112{4/08) I (Continue on Back) —► —► —is <br />