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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU- OMER TO PROVIDE <br /> OWNR NAME <br /> j' rek,rt' ii Cj Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) D ed Restriction; CSM <br /> 3111- /iZc'L 77,1 r Lrlz' 3`"-S57.3Z ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 46e ``S:2-r-s le Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ,le.iJ e__ P 244 ! CCa.k. ,4 Gvi2S7/�t_e_i/v!Z to Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> `20 k,-(14i1c R 67 / S% <br /> (City,State,Zip) 7 (City,State,Zip) Setbacks <br /> 110e.re)re_57—1.33 5` S`J taltdsor) 1—)2 3-:is-- •e <br /> PHONE PHONE Eo Plan proval from <br /> 6j 7`" 75— t ''"f' --E-MAIL ADDRESS E-MAILADDRESSgs DL 20J 51- - , , - a a2 or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) vation of property <br /> PARENT P_ARC NU ��;�q�r0,.,O CURRENT ZO ING: ACREAGE: P P Y <br /> ❑PARCEL aY1 , � j . frontage drawn to scale. <br /> NUMBER / <br /> TOWNSHIP: SECTIp IN Ilk ... 0 <br /> 1 1/<: N 1/1/4: /� ❑Driveway permits <br /> ADDRESS: <br /> ,p - ,p tate,county,town)t_t A.C A <br /> 77 ©f� i a7Z)12 /w.C_ bcc/LY- (�. Sanitary <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> / (public, pvate) <br /> ��2j- <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 5j h1/E___ liy //orze ! i A( ', ing©istrict <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: �h l Ifde Address <br /> EWER i7EPTIC / 3- 2j: �6 —Gam/ 76 (new `xisting) <br /> HEIGHT IN FEET: r NUMBER OF STORIES: (Not including basement) <br /> / j El Wetlan oodplainJ <br /> Shot* nd;(a nt) <br /> AREA TO NEAREST SQUARE FOO : <br /> (Outside dimensions including unfinished area,attached gar es above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: �a� ErosionCo OI permit <br /> jilt 0 1y�0 1- /�10 6O r ,T-TOTAL SQUARE FOOTAGE: 4, (slopes, sturbance, <br /> 2ND 3RD FLOOR: 3,)se 0C Q Y I flllfn ) <br /> rA ■ <br /> U Review Location Survey d <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ --► t,� n 7 © '---. and available options. <br /> (Please round to nearest dollar) $ 302 Qe, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [ lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ao ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Elves JIo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank' none) <br /> 6. Is a location survey required? (see reverse) 65Yes o ❑Don't know <br /> 7. Is this to correct a violation? Elves ENo <br /> (Continue on MUST - SIGNED <br /> 545-112(4/0812 APPLICATION O MUST ♦ ♦SIGNED <br />