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-74 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 514P1t E..-I LLAI i L AID ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> VS Ob FSFACELL P►J PHONE 5 A1RlSS tJ►S S. 535c10 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS t <br /> •: 1`lobil4 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTACTOR NAME <br /> SRIrty a r11t1ER 061t0l 55'DX— ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 115 v3, ci f,4 6 . <br /> State,Zip) (City,State,Zip) ❑ Setbacks <br /> 504K1 'P4i►R1 ,�t5 . X3-40 <br /> PHONE PHONE cEAL. ❑ Site Plan approval from <br /> 831-(o01, Sib-bDBO applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLus/) <br /> PARENT PARCEL QQNUMBER: <br /> q t_ CURRRcENTTZONING: ACREAG ❑ Elevation of property <br /> ❑ NUMBER oi4-oSib-25 21b'1-�O zGlic- '� I t 7 c frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> (3t1S4'{E NA) 1/4: t.SE 1/41/4:1525.3-&S 1O state county town) <br /> ADDRESS: <br /> 52,WPWSEROclint3`J cI.Ack. 511n1► IRiE uD1S. 53590 ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> 'r7 BUCK.at��lc� <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW' <br /> PROJECT DESCRIPTION: <br /> ' 1-1 SP►T):1'RD0111 Pa)n100 CI Zoninit Zoning Dist!** <br /> ❑This project is a new building or structure. 'e ; <br /> ❑ Permitted Use?, <br /> XThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> ❑ Rural Address t <br /> ❑SEWER A SEPTIC 420\17 (new/existing) "" <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 22' 1 ❑-NVetiarI{ N <br /> Shorefan t): <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASE NT 1ST FLOG � � ..1; <br /> '50 4, TOTAL SQUARE FOOTAGE: 4, i w :-. a. ;„f <br /> ter[[ ( .���yj� <br /> illi /ac i E” £5 <br /> 2ND FLOOR: 3RD FLOOR: q �Q - <br /> Reviewl cati0t)turvey <br /> ESTIMATED CONSTRUCTION COST: and a1fariet 1S <br /> (Please round to nearest dollar) -. -. -. -♦ -. -. 60,000. <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. Is there 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 and are they in agreement'? 0 Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Si 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 ®No ®Don't know <br /> 7. Is this to correct a violation? ❑Yes 0 No <br /> APPLICATntinue ION on Ba MUckS)T BE-►SIGNED <br /> 545-112(4/08) <br /> (Co <br />