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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> • <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> t°vi o f lief M°.n / Zoning Status; CUP; <br /> WNERADDRESS (Number,Street,City,State,Zip) eed Restriction; CSM <br /> W0 l 7 Cr T 8j �h1r�j1 ar S3S S riance(# ) <br /> HOME PHONE CELL PHONE <br /> E-MAIL ADDRESS 7 b 7 S 7 g yd 6 u She ; v en/@ hT .. u�7" „ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION -nd includes dimensions <br /> AGEN NAME c� / CONTRACTOR NAM <br /> �}/�� S/1 ,%1/t e- 4-ek N AO r',7 5 1111 - 'Ian i. :ding location <br /> EN ADDRESS CONTRACTOR ADDRESS of we .-ptic <br /> - w i/ / 8 A. ftp.M r <br /> (City,State,Zip) (City te,Zip) etbaclCS <br /> M fi g r U9% s357a M.LA It- AVS S3 5 17 <br /> PHONE PHONE Si 'I-• -•proval from <br /> 6 0$ H 3 7 3 7.3 6-- 7g 7- '800 pp. •le township. <br /> E-MAIL ADDR SS E-MAIL ADDRESS <br /> S A e r v zO c- N16.(V el ' oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL N MBER: CURRENT ZONING: ACREAGE: m levation of property <br /> DPARCEL O frontage drawn to scale. <br /> NUMBER r0 0 O 706../S3-!77O'� C - )- !• I <br /> TOWNSHIP: SECTION: <br /> Ve tr M o id- /S 1%: ,s F '/41/4: 0 (),) Drivewa rmits <br /> ADDRESS: (state U ty,town) <br /> y© 1 7 C 7 H .z- & L, A Ept7/1 A))1. 53S/S anita mits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, ate) <br /> PROPOSED PROJECT INFORMATION STAFF EW <br /> PROJECT DESCRIPTION: <br /> Al N 30 X 33. onto e X;.s/r A q z to r Pr- s A e,A Zoning District <br /> ❑This project is a new building or structure. d O [i,rpermitted Use? <br /> UThis project is an addition/alteration to an existing building or structure. ✓ <br /> SANITARY SERVICE: / -E: PERMIT NUMBER: v/4 ,Rural ' •• <br /> EWER EPTIC 'j •j, <br /> HEIGHT INFE T , 1 NUMBER OF STORIES: (Not including basement) <br /> Wetlan• FI•••plain/ <br /> REATO NEAREST SQUARE FOOT: <br /> Shorela . (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) rosion on of permit <br /> BASEMENT: 1ST FLOOR: <br /> 9 6 /�V 4 TOTAL SQUARE FOOTAGE: j (slopes, •1 rbance, <br /> 9 Illing/- • :) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 0.0 e,'-', Loca'•nSurvey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ -► ♦ ♦ ♦ ` / and avai = - Options. <br /> (Please round to nearest dollar) $ .3 3 �.J D 0 <br /> j <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes ['lo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes fl i o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Yes III o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes 51No <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 Fr/ o DDon't know <br /> 7. Is this to correct a violation? Dyes k7∎7 o <br /> APPLICATION MUST BE SIGNED <br /> /� �!� ) - n / ') (c) (Continue on Back) ♦ ♦ -► <br /> 545 112(4/08) `J ( J <br />