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1 l , (o- <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOM TO PROVIDE <br /> OWNER NAME . <br /> V li r,CP— s <br /> Ct,5 c \ roJ\A\ ❑Zoni g Status; CUP; <br /> t i <br /> OWNER ADDRESS (Number,Street,Ci tate,Zi <br /> z-ni C�on y D ,e \V■M W35�O Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE PHONE E-MAIL ADDRESS <br /> • " • ❑Site P yawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and in des dimensions <br /> AGENT NAME RACTOR NAME <br /> d�,n∎nA S £r Ujol `\,M el a Plan including location <br /> AGENT ADDRESS CONTRACTOR ANDRESS Ztnrell/septic <br /> 62L0 C.ommarciaiL Me <br /> (City,State,Zip) (9ty,Sta ip) ❑Setb( <br /> PHONE uM'ra%r' e_ .*Li 5359b ❑Site Pla' a•*I-from <br /> " u c MrVI Z�1.VIA 0(4144'\("$ J1 '(D3I�_ appiic-. : ip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS Z:opr plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUM ER cat -2DLI -9245 -Z Rvc - 14 Asia- frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> \ OUY\ orr &unPrct..k r i 2 1/a: '/<'/<: ❑Drive <br /> ADDRESS: .L (state,co n y,town) <br /> 2-71-1 1 *y�� \ 6l�r∎ 1 ro.∎ r% ❑Sanitary per r s <br /> CSM: L SUBDIVISION BLOCK/LOT <br /> \I3 o% P 3B 2.. (public, , <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / <br /> Ki:_c_fAP S(A i (1,/, trttli Zonin jsfrict <br /> . ❑This project is a new building or structure. ❑ Permitteerd J? <br /> j2Ifhis project is an addition/alteration to an existing building or structure. V <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER 7'PTIC (new!-a, •) <br /> HEIGHT rV FEAT: NUMBER OF STORIES: (Not including basement) <br /> 1�\ _`JI``,� ❑ Wetland/Floodplain/ <br /> `'J Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: Li 1ST FLOOR: ❑ ErosionControl permit <br /> �/ (� 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: 1 filling/access) <br /> ❑ Review! ••- ey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and av- lad op ns. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes E 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? Rt'es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑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) Oyes 121Vo ❑Don't know <br /> 7. Is this to correct a violation? [Yes Olo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ - –► <br /> 545-112(4/08) <br />