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c . <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web App'#' <br /> :PROPERTY..OWNER:INFORMATION _ <br /> OFFICE'USE.o N LY <br /> OWNER NAM ^ V 1 T l g <br /> R � h �—M�. ❑ Zonln Dlstnct <br /> OWNER ADDRESS (Numb Street,City,State,Zip) �c c� <br /> CIO 1______ AA CA-CS -Ae �uraE}TrJ 4 • W) �J ._1_ `Ii Permitted,Use?.. <br /> PHONE E-MAILADDRESS <br /> �p� _ 01�— b4'ivt ,. e steles �Irn-� �� ❑ Zoning Status; CUP <br /> AGENT INFORMATION. .''' ._`., ft } i'`,.,. :r CONTRACTOR N. FORMATIONS 11,E{;'? ��a'r., Deed Restriction; CSM <br /> ar- T NAME CONTRACTOR NAME VarlanCe # ) <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> ❑ Sne Plan drawn,to scale <br /> Stoles e‘ner K-1> and includes dimensions <br /> (City,State,-Zip. (City,State,Zip) <br /> 'L, Ve-14114%emsw\ 53590 ❑ Site Plan includi g locaton <br /> PHONE PHONE of,well/septic <br /> E-MAILADDRESS E-MAILADDRESS ❑ Setbacks <br /> be ar a4 , A -(a� , �,fi <br /> 'PROPERTY lLOCATION'7NF,ORMATION.;+ (httpe//acaessdalne`codanewi:iusn° }'I' ' :_ :'❑ Site Plan approval from <br /> PARENT PARCEL NUMgBER: nn ZONING: ((u,,$ ACREAGE: 5` o41 ; ;applicable township <br /> PARCEL ©�1a 'a�a"lO� j F—` i l/f <br /> NUMBER <br /> TOWNSHIP: SECTION: +I , l 1- , ;Q RUf"a1 Addl'e5S a <br /> (� Alp 1/4: !4 W 1�41�4: 51j tr s <br /> JUY1n (new/existing) ° <br /> ADDRESS: ('� T <br /> �i ( O C m learn b R .1-U vG If-Tpr.� I (�` 6 3s 9 t Floar'plans to scale <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 1(P 5 ',p� of .) D,Elevation.:of property <br /> PROPOSED PROJECT INFORMATION, ., . 7. ''.: �• • ` i_ t '. frontage drawn to scale. <br /> PROJECT DESCRIPTION: (Z'8 ` ( 10 47 <br /> C6' X 4ab►le Nome_ <br /> �S X Zi)t deck wj S4 )rs '�C4 Q la)Sbh(S `D 1Drtvewaypermlts <br /> . ®This project is a new buildins or structure. Gg x�N = 1232 <br /> state,"county, town) <br /> ❑This project is an addition/alteration to an existing building or structure. Q,Sanitary permits <br /> SANITARY SERVICE: PERMIT NUMBER: (p t(bllc,pkrvate)= <br /> 14 SEWER ❑SEPTIC E i' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) Q Wetlapd/FIOOdplaln/ <br /> IL ' Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: ill y ; <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) 0 Er'osionContraipermii <br /> BASEMENT: 1ST FLOOR: �SfOpS,distUrba ice, <br /> • ,, TOTAL SQUARE FOOTAGE <br /> I l(1y !:'''''''It J' ' filling/access) -- <br /> 2ND FLOOR: 3RD FLOOR: rx . <br /> 14014 ❑ Ei tiew Loaion Suf <br /> rvey x <br /> ESTIMATED CONSTRUCTION COST: $ LI 000 and avallabte optl0ns 4. <br /> (Please round to nearest dollar) <br /> 4 15,5 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 0 No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes No ❑Don't know <br /> 3. Have you talked with the township about your project? Yes CI No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes EI-No <br /> 5. This project is associated with a rezone/CUP/variance (petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes VINO <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —0 -+ <br />