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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App s <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ,�y t +�Ue tre i*v l .l (L�t�I da lu f QZoning Status; CUP; <br /> OWNER ADDRESS ( umber, reet,Ci y State,Zip) geed Restriction; CSM <br /> HOME oci C CELL PHONE \/ �IILAD h I`) �i S , V riance(# ) <br /> --i foaD lite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION nq includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Vt(t 1r T c l -3 1 f c Si e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDR S o well/septic <br /> (City,State,Zip) (City,State,Zip) �y I Setbacks �� <br /> PHONE PHONE Hounds s `i ❑Si Plan oval ft'' rom <br /> (O� 431 �IQb i a p le township. <br /> E-MAIL ADDRESS a E-MAIL ADDRESS / <br /> H1-1. <br /> Y 51-1.0 0 C'ewi oprnent:i.,on'1 loo plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) EIIQv�{ion of property <br /> PARENT PARCEL NUMBER: CURREN ONING: ACREAGE: r" t, <br /> El PARCEL NUMBER [SAO-9 71 I-¢ ( {� (� f'orrfage drawn to scale. <br /> TOWNSHIP:} SECTION: • J, <br /> 1 l 1 W,\l� 1�4%: E Crtveway permits <br /> 1� �l a �' V ttate, county,town) <br /> ADDRESS: (�� <br /> C M 2 \C) r 6 Sanitary permits <br /> CSM: i, . p LOT I SUBDIVISION BLOCK/LOT (p blic, private) <br /> • r <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: t C oning District <br /> This project is a new btliiding or structure. U Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. ,-, <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> ❑ '+ -l Address <br /> EWER 1 EPTIC t 7J-- 2-Di ci2 (nev,f/existing) <br /> HEIGHT IN FEET: r- ' �N ' uding asement) <br /> �� ,`l ' cs oco (�CCE' S r '� Wetland/Floodplain/ <br /> V 1 Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: . <br /> (Outside dimensions including unfinished area,attached garages and above gr <br /> grade decks or porche ) t. <br /> .. ksionCOntrol permit <br /> BASEMENT: 1ST FLIQR' <br /> '2 1 'Z ? / i j'�7 j TOTAL SQUARE FOOTAGE: 1 (slopes, disturbance, <br /> 2ND FLOOR: •/ . R t OR: e, ws-e- Gh / 41k c filling/access) <br /> 190 S2 / Review Location Survey <br /> ESTIMATED CONSTRUCTION COST � � ,-v� fi 0 Ii1 I� vailable options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ -► (JCS �I (� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EIYes No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes No ['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? QYes ONo <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 Q,No ❑Don't know <br /> 7. Is this to correct a violation? ) ��Yes g o <br /> , . , e <br /> S 4/0A.t..< APPLICATION MUST BE SIGNED <br /> 792 Q ^�U (Continue on Back) -♦ <br /> 545-112(4/08) ` e' S <br />