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• 3 c.,4` -7 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-A pp # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> n''oE YAC. J..)-6 tit2z., [(Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> Llet S 9 CoTr" ('om:NGE GrZAVE ) c..� t,S. Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ..-G --' of Site Plar�rd� «: e <br /> AGENT INFORMATION CONTRACTOR INFORMATION and inclildt+s 1-nsi•• <br /> ti <br /> AGENT NAME CONTRACTOR NAME <br /> 1-ca. H Ac-IC.L- M 5ryC..E aN7-12 gcya,ei-f ' ite Pla in ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/se is <br /> A- 3-15-7 tA 1-1,i 14f S A f`f Er. <br /> (City,State,Zip) S3 (City,State,Zip) ErSetb?5.1 <br /> SP12.• 4, 4l > � w1 Sc►b..`�— <br /> PHONE PHONE Q Site Plan -p• rom <br /> 60V - SS8- '-E0314 SAr+/`IE__ applica•l • ip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> kp C L, .Wit • 14-/A I- ErFloor plans to s le <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> �f PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of prop <br /> PARCEL <br /> �°-'NUMBER •: it 34 19-514, ) Re-s. ' frontage drawn to s le. <br /> TOWNSHIP: SECTION: <br /> Su x..) pkA t 2t W '/4: N ME %IA: EDriveway permits <br /> ADDRESS: (state,county,town) \ <br /> 'Pt E 2CEtjCOtt.� IeoAr7 1 <br /> Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT 4.4 <br /> ' _Cos I (public, private) ((f PROPOSED PROJECT INFORMATION b <br /> PROJECT DESCRIPTION: <br /> STAFF REVIEW <br /> ❑ Zoning District <br /> . This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER IEPTIC 3^Z O /GO CIO 18 1 (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Zp -- it ( ❑ Wetland/F000dplain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: n / r ❑ ErosionControl permit <br /> S S, ,� ,p_--! ? 5 TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> �6' filling/access) <br /> 2ND FLOOR: 3RD FLO R: i <br /> 16 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -�► ♦ ♦ -�► ♦ and available options. <br /> (Please round to nearest dollar) 3 1) ZO o o0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes F2 o Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Efres • o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes "lo <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 174 o Don't know <br /> 7. Is this to correct a violation? QYes 2No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -. — -. <br />