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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ,,//// .,1 -C e � 115 /13 )''''�S J c, ['Zoning Status; CUP; <br /> OWNER AD /EESS (Number,Street. ' ,Stat ip) ,,/ �r �r, ,� Deed Restriction; CSM <br /> `7� / ifs !�`!/,// G !/'/ C� -� fj LC[i- Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRES9'// / <br /> — .3av : ^c-crae) ' 0$%'1 19!004r 67 /e---V-1-1°-1 Ite Plan drawn to scale <br /> AGENT INFORMATION 'CONTRACTOR INFORMATION and includes dimensions <br /> AGENE CONTRACT ME <br /> J ,6,-, a, , /1,' S-Site Plan including location <br /> AGENT ADDRESS `, CONTRACTOR ADDRESS of well/septic <br /> A•Ci ‘/W. <br /> (City,State,Zip) (City,Sta e,Zip) backs <br /> PHONE / PHONE 111-51te Plan approval from <br /> G{,-_ 4-g--4-'5"--9-0 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 041 h,t!J�Ai 54,1 P ,,4)/, loor plans to scale <br /> PROI'I RTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> ❑PARCEL 05-Vce/!3419`WV',C� /5L7 /''X s 6'2 frontage drawn to scale. <br /> NUMBER r- ua <br /> TOWNSHIP: SECTION: <br /> St f,-7 PL6r, ,r0- ,3c./ 1/4: s gr 1/41/4. , ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 4/ '?K ' 'Cr e`` vide Roe/ ❑Sanitary NA- <br /> permits <br /> CSM: LOT SUBDIV SION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 4,47( / , efa,_ 7r PQ'vo 7 n oning District <br /> . [, .This project is a new building or structure. °•I x / Co Permitted Use? <br /> This project is an additio /alteration to an existi g building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: __---- ❑ Rur <br /> EWER PTIC _ (ne existing �j <br /> HEIGHT IN FEET: NUMBER OF STO�2IES: (Not including basement) (� <br /> l / ❑ Wetland/Floodplain/ 11 <br /> 1 \ Shoreland (attachment)t`r L <br /> AREA TO NEAREST SQUARE FOOT: �Q <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) evQ .J <br /> ❑ ErosionContr ermit <br /> BASEMENT: 1ST FLOOR: <br /> 3 6 4, TOTAL SQUARE FOOTAGE: 4, (slopes,d' rbance, <br /> fillin cess) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 0' ❑ Review Location Survey V v <br /> ESTIMATED CONSTRUCTION COST: ♦ -p ♦ ♦ ♦ ♦ $ / cam- and available options. <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? es ®No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Wes <br /> ENo DDon'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? ❑Yes IgNo <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 KNo DDon't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> _� APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► <br /> 'N' 7 S P 545-112(8/09) <br />