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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App <br /> PROPERTY OWNER INFORMATION S MER TO PROVIDE <br /> OWNER NAME <br /> Pe2, �e,A r2 K <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Z ning Status;CUP; <br /> 3( Li 8 Kerr Pfe2 1 r t1 h4 ,Le-lux-) c ` eed Restriction; CSM <br /> Clad �U ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> hoe G9?'-35-48 e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and in udes dimensions <br /> AGENT NAME CO CTOR NAME <br /> b u'`viLie fA-'2Wa✓q 'awal/ Pot)C'S Sit Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ell/septic <br /> 3 arg coo ,. ice FQ <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> rVl 1101So Ai ,try rf S3 7/ 8 <br /> PHONE PHONE p El Sit Plana oval from <br /> �DU` 222-173v a plies a town <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> c4uirsc.ue 64ce-c,0p1 1 POO LS, �o.. loor p s to sea <br /> PROPERTY/LOCATION INFORMATION (httpa/accessdane.co.dane.wi.usn Elevation property <br /> PARENT PARCEL NUMBER: CURREN ON1r: ACREAGE <br /> 0 PARCEL BER 0350708 301-(076 — Ir ? fronts draw o scale. <br /> TOWNSHIP: SECTION: <br /> P'l I Q u-_---7?)A...) 3D %: cjC 1/4%: M L ❑ Drivew permits <br /> ADDRESS: (state coun , own) <br /> D Sanit.- permits <br /> CSM. LOT ) SUBDIVISION w �, BLOCK/LOT (, • c, private) <br /> 1 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 20 1 X I4 , fend J J / Plo L_ ■ ,oning District <br /> . This project is a new building or structure. <br /> NO Permitted Use? <br /> This project is an addition/alteration to an existing building or struct e. <br /> SANITARY SERVICE: PERMIT NUMBER: A ❑ Rural dre <br /> EWER —�_EPTIC A (new/ =tin <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not inclu.ing ba ement) <br /> ❑ Wetland/Flo lain/ <br /> Shorela (attac nt) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionC rol permit <br /> ,` TOTAL SQUARE FOOTAGE: 4, (slope disturbance, <br /> fillin access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> SCI_)8C-/�ttLJ,G <br /> ❑ Review Location Survey ac ESTIMATED CONSTRUCTION COST: ♦ -► ♦ ♦ ♦ $ / rs- and available options. <br /> (Please round to nearest dollar) .p�51 t. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies N ,Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes o ,Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes DNo 0 d'-k),[10 <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) Dyes rEINo DDon't know <br /> 7. Is this to correct a violation? DYes �No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) .--1Y 1 Cl -` (Continue on Back) -o. -► <br />