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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�r >< Le to r1r7 �1 ac1.- e1, 0 Zoning Status; CUP; <br /> OW RADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 84/!> zoo, -%T 42- PI/46.'10M Dt.4 SOK 16./Z S 3S 7 Variance(# ) <br /> HOME PHONE CELL PHONE E-M L ADDRESS <br /> Lvet-22s--£74 0 4456-226--67 L/ ) 9 I Ac+-s clie Iseeks 11c.ecsio-, LI Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGE,UT NAME J CONTRACTOR NAME <br /> �Yh Fe1/i Seluo 614;1d-err LL.e' 0 Site Plan including location <br /> AGENT ADDRESS CONTACTOR ADDRESS of well/septic <br /> IU? ,27 A >°/sue Rd. i,,-)222--7 A-1 aivl,e Q-41, <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> ' .1 1' /01-- s3 5--.1/ roddL h b/f s7S 2 <br /> PHONE PHONE ❑Site Plan approval from <br /> oc 5-7L5---$ 13 6— 577-SS-6 3 applicable township. <br /> E-MAIL ADDRESS <br /> E-MAIL ADDRESS <br /> e J/1 .S' Lie/4 a ,• GO1`7 L ic.11 .S UOlc4Q 144a1;1 <br /> ❑Floor plans to scale <br /> _ <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLus/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> 11 PARCEL /� cps';S32 ,,L�• frontage drawn to scale. <br /> NUMBER O,SS!b1�07-023-BSb1—o �+-I A5 <br /> TOWNSHIP: 66 o 7 Q Z3 Z D SECTION: 5 2:11-70, Ng-1 <br /> S��prck da142 -Z 0 NW ,/4. '51.4/ ,/4 ❑Driveway permits <br /> ADDRESS: S (state,county,town) <br /> 3666 Al rá4,. �tw 72, yey-rveet Gtr ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (17 u,�ks. 124. e (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 45 11.411,E Lvt Ai ❑ Zoning District <br /> . EIThis project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEWER REPTIC 13-Z o 1tv -60/12 (new/existing) <br /> HEIGHT IN FEET:, �� NUMBER OF STORIES: (Not including basement) <br /> 2� - 2 ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> Ici5 r-c,,I-(Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> 4L (led. BASEMENT 3 1ST FLOOR: ❑ ErosionControl permit <br /> /�Z� + TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> �t� 5°1' �b S filling/access) <br /> 5 2ND FLOOR: 3RD FLOOR: <br /> II 2 racy 7/6 77_Z-7 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ Q and available options. <br /> (Please round to nearest dollar) �V � <br /> ` 4 5,06 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres to QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? aes EWo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es QNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes VNo <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) QYes ENo ['Don't know <br /> 7. Is this to correct a violation? Efres Olo <br /> �/ APPLICATION MUST BE SIGNED <br /> E C Orr_ O J G (Continue on Back) -► —* — <br /> 545-112(4/08) r l v <br />