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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to W.I-App S <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> pr.ER NAME <br /> t.-4•1N .N Ast 1 k _ oning Status; CUP. <br /> OWNER ADDRESS (N,m Stee :v State Z�i Deed Restriction: CSM <br /> 3H0z 5,.. ,,.. M-pL (�,,` Variance (# <br /> :`E PHONE CE_: ONE E-MAIL ADDRESS <br /> 668 414 14"S571 Nt AA,,HM;'(Q , :I.tv.-• e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> \"-.4,� 1k.-t (Su-s- Mor-6, g:ai :rte Site including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS V of e I eptic <br /> 2.3 S-S- L`..r s IQ.- M"' g..1 <br /> (City State o Z3SS Chr;s u.,- M.. Nk. <br /> ;City.State Z: 1, C <br /> 'Da U,14 1"'i —_-535. 3---- _od1.0•1k_�- W 5 3M. <br /> PHONE PHONE n Site n proval from <br /> (o -c1't- i to(a (008 -49 5 - 1381-I applic e township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> � F or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El ation of property <br /> PARENT PARCEL NUMBER: CURRENTZONING: IACREAGE: P p y <br /> C NUMBER 103,3/07,,,,i3_332-9 So D A - 1 ! I$4.% 1 j rontage drawn to scale. <br /> /TOWNSHIP: SECTION: <br /> m4&\tic-6- 3-. '/4: SE %4'/4: fJ(,t„) C Driv •ermits <br /> ADDRESS (sta ', aunty, town) <br /> 3L10 Z Sti/ . l u <br /> Sant y permits <br /> CSM .T, SUBDIVISION BLOCK/LOT <br /> tM <br /> (public :.rivate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT D SCRIPTION: <br /> A .V:0.-- + SW\ bext• r ning District <br /> This project is a new building or structure. i P mitted Use? <br /> 1 (This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: 1 PERMIT NU).\,7 BE ❑ Rural Ad ddreess <br /> NEWER [SEPTIC ! (ne . -----7 <br /> HEIGHT IN FEET: J I NUMBER OF STO S: (No including basement) <br /> z-o' L,, =/� I ❑ Wetla : :l:plain/ <br /> ••relan• -ttachment) <br /> AR TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: Erosions• 4 permit <br /> 1050 4, TOTAL SQUARE FOOTAGE: 4, <br /> 1obp (slopes ' urbance, <br /> V filling es <br /> 2ND FLOOR: 3RD FLOOR <br /> i —_ eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) -► ♦ ♦ ♦ ♦ $ (1,`315- 0 <br /> / v <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ]Yes XNo [Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes gNo rpon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? I JYes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? tYes x No <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 fNo Don't know <br /> 7. Is this to correct a violation'? TlYes ]No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ <br /> 545--.2'4/03: <br />