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, , /00 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> GREGORY A MflIIJ ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 2.8a0 LAKE.iJ000 CtKLE Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ,0$-$3$-%IU ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME M,fiTT S,ti AW CONTRACTOR NAME <br /> SNPw Bvt41N6 a- DE5161\J ZNC • S.V\AO GUit..13lN6 4' OESI ,U Ilt. ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3I8S QEER PotioT DRIVE 3185- 0EER Po'NT ORIUE <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> STav(1NToN WT 5-J5g9 .5-T0Q6A-Tor.) iT 53SgR <br /> PHONE PHONE ❑ Site Plan approval from <br /> ‘O g'- g77-(13 i (,08- 1?-77 — 113( _ applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> /YIR'rr E' SNgr✓g j c. CGM a')qr-r€ SNJtk)8 viLt2 RS. cOM ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER (:'1b/ObSI-o1a-99io-o A-1 1=X 1.3 <br /> TOWNSHIP: SECTION: <br /> '/a: '/a'/a: ❑ Driveway permits <br /> PLEASANT SPRt N6S (state,county,town) <br /> ADDRESS: <br /> CSM: LOT SUBDIVISION BLOCK/LOT El (public, permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> la Zoning District:140,',` `;. <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 /> new/exls(in <br /> ❑SEWER GEPTIC� ( Y <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 14- r `/'�► ��- I ❑ UVeflartd/rlao¢plal <br /> AREA TO►NEAREST SQUARE FOOT: Shorelarrcf (afacrnen <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ❑ ErvslonContro#permit <br /> BASEMENT: 1ST FLOOR: ,+, TOTAL SQUARE FOOTAGE: ,` (slopesildisturbances <br /> �� filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 541 D ❑,Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -, and available options; " <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ ��I O O „ ,, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑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'? Li Yes ❑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) ❑Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? CI Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —i► <br /> 545-112(4/08) <br />