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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME WU D S-h NgES 0 <br /> 1 onjng Status;CUP; <br /> \ OWNER ADDRESS (Number,SStreeL City,State,Zip) w'}t 2��� Deed Restriction;CSM <br /> 551 1341 � � � ���� W I �J�"� Variance(# ) <br /> HOME PHONE CELL PHONE ADDRESS <br /> 'te 1, _' LA _cir /. -SiD utCe v.-QC; tl 1 't044 Etsife Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> SQA1-I E.lectt,(- [0461;including location <br /> AGENT ADDRESS CONTRACTOR ADD ESS of well/septic <br /> 4,43 70 4u rr COLIC St <br /> ( • ,State,Zip) (City,Slate,Zip) Se CkS <br /> �/re4C N Vim) \ 5 35-6 <br /> PHONE PHONE cJ <br /> Q Site P P . ap•;oval from <br /> (c0� U 3 G - ��y� app. .• ownship. <br /> E-MAIL ADDRESS E-,AIL ADDRESS <br /> O) .•r-JL J.2Cx'K.+L . CQ AA laFT or •.- to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 4 ' ation of property <br /> PARCEL �. a < ` t ) < �/ ontage drawn to scale. <br /> y <br /> NUMBER /citc j •331-$Q&C-0 I:1 1 E ■ / J , <br /> TOWNSHIP: SECTION: <br /> �/ Care-col) 33 5 -`ik)4/4: N67 1/41/4: N; ❑Drjv permits <br /> ADDRESS: <br /> J e,con ,town) <br /> --7-) '--\\ t= ' fDO C. a kt4 11 i 5 )C.-,• ❑S. 1 •ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT 01, jC, .rlVate) <br /> 33$ <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> x\G c- Pam G{`,,k 515�le rv'l Z mg istrict <br /> . <br /> This project is a new building or structure. <br /> P mitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: / � (( Rural • •• - s <br /> [)EWER N l. <br /> EWER [EPTIC <-� - v'al (new/- fisting) <br /> I, HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> Wetlan•'qf•'••plain/ <br /> Sh• - .nd .ttachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: Erosi• ' o of permit <br /> N A iu to ,, TOTAL SQUARE FOOTAGE: j (slopes .is . bance, <br /> 2ND FLOOR: N A 3RD FLOOR: r O+ <br /> glint .ccess) . <br /> J( 8 Review 1.••.tion Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ D� r:31:70 <br /> and av-'a.•le optio S. <br /> Please round to nearest dollar) <br /> The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des EiNo DDon't now Q <br /> 2. Is there a wetland or floodplain on or near the property? Des ao QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? E]Yes Elo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Elves [ Jo <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) Elves Elo QDon't know <br /> 7. Is this to correct a violation? QYes Flo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -. -► <br /> 545-112(4/08) <br />