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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU=TOMER TO PROVIDE <br /> OWNER.NAME <br /> _Apo146,5 AN 0 kA 4.16- 3,,'." iktAN Cj Zoning Status;CUP; <br /> OWNER ADDRESS umber,Street,City,Sta Zip) � r Deed Restriction;CSM <br /> 36 u 6 re L,H A 1ko 114P'n4 5tM S 31 `3 riance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> I °6 b5i S pm£ �- Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME 1 CO TRACTOR NAME f <br /> 6 A/Yt.Q A s co N�l✓l M-4- .— T Tk,v{,t4/15 Ve5 i fi,': Cot=5T, to Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS ! f well/septic <br /> L/5 33 ELLI/v(77oN <br /> /4 <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> III t on t'eroN (i)j 535(2 <br /> PHONE PHONE ❑Sit= 'Ian a 'ii from <br /> �O� - 5�� - '4I to 3 a ,. ica ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> -1-No d ffl g 2� VP. C e £ot l r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARC NUMBER: -�s, CURRENT ZONINQk ACREAGE: s Elevation of property <br /> ❑PARCEL 0333 670,5-30.-1213--0 .e 5 k 0 _H' ( 9 6 c I "S frontage drawn to scale. <br /> NUMBER 7 J <br /> TOWNSHIP: SECTION: ,,1 <br /> -' .O W N U' to ri c-e-fuN 2j 1/<: ! NI '/a'/a:s V,! ❑P eway permits <br /> ADDRESS: <br /> t e,county,town) LCD <br /> -78 4 N 0 L L kiA LL-et{ 2-Gk..0 <br /> CSM: LOT 3 SUBDIVISION BLOCK/LOT Sanitary permits <br /> 801ALLe (• blic,private) <br /> -1-- <br /> PROPOSED PROJECT INFORMATION AFF REVIEW <br /> PROJECT DESCRIPTION: tt <br /> NE W /4 0114E Con,.)541,t c`t I b/l/ • oning District <br /> . . This project is a new building or structure. Ir Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: i • m 'Address <br /> EWER XEPTIC i i - 2t)!(- Q uo p Co /existing) <br /> HEIGHT IN FEET: _..-, NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/F in/ <br /> AREA TO NEAREST SQUARE FOOT: Shore) (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ EroSlonC <br /> .'7/• "2 it .7 �.730 II p2 3 j TOTAL SQUARE FOOTAGE: j (slopes,di" a:R <br /> 2ND FLOOR: 3RD FLOOR: filling/a•. -) (�`t <br /> 21 (p CO ❑ Review Location Survey ! 0 <br /> ESTIMATED CONSTRUCTION COST: ♦ QQ '7 and available options. <br /> (Please round to nearest dollar) $ 1 2 G , 000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 'lo JDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o �on't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yeslo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank i none) <br /> 6. Is a location survey required? (see reverse) ❑Yes z o ['Don't know <br /> 7. Is this to correct a violation? Dies 1 o <br /> 545112(4/08) 44 CI 3 0 APPLICATION MUST BE SIGNED <br /> �� (Continue on Back) ■ -♦ -► <br />