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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN ,f4 NAME <br /> Wir eSit,r MaID G Pry a Fri.1 clic Wing Status; CUP; <br /> Vb <br /> WNERADDRESS (Number,Street,City,St'aty,Zip) Deed Restriction; CSM <br /> 14.1 tf V kG4 � Rtes Mdr- � g W 53517 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> --b-Zs •1245 otose , r z .. • ■L , I . .i . LoN1 a Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and incl des dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Su t4 MI c itr C4N Zf a Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 13c61y µ- <br /> (City,State,Zip) (City,pStatte,Zip) a Kg tLS C( , W 3 I ' S1 2 <br /> PHONE PHONE J ❑Site Pla a val from <br /> �(.0$ 7,7,S- YZ S appli township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> SbSIAMAICAtr&IDS•IJ vr Et.F.pcfrplans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evatlon of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING/ ACREAGE: p P rty <br /> 0 PARCEL NUMBER 0501• del•9 SSp•(i ft•N•'S IS*'tf frontage drawn to scale. <br /> TOWNSHIP: SECTION: _ I <br /> PR.I�I�ASL c 1/4: N t 'h%: Ivewayp- mits <br /> ADDRESS: (state COU OWn <br /> c1 e /' ' tip permits <br /> CSM: LOT S BLOCK/LOT <br /> A (pu(pub!. ,pnv-'`� 4(31 <br /> PROPOSED PROJECT INFORMATION F MEW <br /> PROJECT DE \\JJ CRI�T�DMA <br /> //LL Win District <br /> ®This project is a new building or structure. <br /> ❑ P fitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PER I UMBER: n ❑ (Address <br /> EWER RIEPTIC 7 --a-0)4:`�/3,1J <br /> 411.0 isting) <br /> HEIGHT IN FEETj� / NUMBER OF STORIES: (Not induding basement)_s <br /> 1//J/�y_I 3 ❑ We - d/FI•-•plain/ <br /> Sh• -! •t (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> L E���-- <br /> rosionCont • •ermit <br /> BASEMENT: 1ST FLOOR: , <br /> Z I S S 3 1 1 j TOTAL SQUARE FOOTAGE: ,l (slopes = •- <br /> filling/a• - �,� <br /> 2ND FLOOR: 3RD FLOOR: ` s <br /> 6-a34 eview Location Survey <br /> ESTIMATED CONSTRUCTION COST -► ♦ Sao 000 and availableVons. 94. <br /> Please round to nearest dollar) • O D <br /> Q <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Lives Ilo ❑Don't know 1;, <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 5Dsio <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) Lives plo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes Sallo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —t• <br /> 545-112(4/08) <br />