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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App X <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWI/A.)R NAME 4 <br /> cell an crep lie-i twe e H7 t l et,e- 4zoning Status; CUP; A ( <br /> OWNER ADDRESS (Number,Street,City State,Zip) 1 l Deed Restriction; CSM <br /> 7955' ALrrlv2 4 r< , 4�aNI4- / i 31:93 Variance(# ) <br /> HOME PHONE CELL PHONE / V E-MAIL ADDRESS <br /> 6043 X8.241 1 i Site Plan drawn to scale <br /> 'AGENT INFORMATION,_ CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME ,-,, <br /> 04 tie l 1 Je // t.} <br /> k.'.co 9// -ea-14)1,S Site Plan including locatio <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 8 C/41,,M1 I2et Ag _ <br /> (City,State,Zip) (City,State,Zip) ,%1 Setbacks "3 0c0L <br /> mIA plse:4Qi L) 5"6 "7J hp <br /> PHONE PHONE KSite Plan approval from <br /> & Ob .. 422 - /7,, Z.,,,) applicable township. N <br /> E-MAIL ADDRESS E-MAILADDRES T <br /> �:(v f�e _f p.ew e/I poet.. Gam 4Floor plans to scale <br /> 'PROPERTY/LOCATION INFORMATION (http J/accessdane.co.dane.wi.us/) a <br /> PARENT PARCEL.NUMBER: CURRENTZONIN : ACREAGE: levation of property <br /> C PARCEL b3$a�0?og-1ci 3208q.9 A — d.q 1 8 frontage drawn to scale <br /> NUMBER O CS -1 v <br /> TOWNSHIP: 0 SECTI N: IV <br /> Pt- lo,G/.,..2' J %: S W ,/4'/4: N a Driveway perm <br /> ADDRESS: '(state,county, <br /> 79{{ 4"' Z <br /> anitary .- s <br /> CSM. LOT SUBDIVISION BLOCK/LOT <br /> •- •s— (publi. privates <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 1 613`X'` 0. SA) #2rJ'J"JCL- ✓.P.:v!f/m Aug 'Po- L_ t<Zoning District 4 / <br /> . QThis project is a new building or structure. `Permitted Use? -T 9 <br /> This project is an addition/alteration to an existing building or structure. A, p#d <br /> SANITARY SERVICE: PERMIT NUMBER: — Rural Add " <br /> EWER 1EPTIC (newt-44010 <br /> HEIGHT IN FEET NUMBER OF STONES: (Not including basement) <br /> Wetland/Floodplain/ N <br /> Shoreland (attachment) f <br /> AREA TO NEAREST SQUARE FOOT: 6 <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ErosionControl permit <br /> BASEMENT 1ST FLOOR: <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, / / <br /> filling/access) Aw 12/A 6 <br /> 2ND FLOOR: 3RD FLOOR: < f L 0 <br /> (/ A Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: i ♦ ♦ ♦ ♦ ����� ci and available options: , <br /> (Please round to nearest dollar) t <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes DNo gDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes riNo [ Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? QYes ZNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes 1No CS,D 14)Nbtd <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) QYes No QDon't know <br /> 7. Is this to correct a violation? QYes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► -s <br /> 545-112(4/08) <br />