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ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME / _ <br /> G leA i- 104x4 t,o/e y Wing Status;CUP; <br /> /OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 3 es 37 Riener - --era-rs`tt Li l 5353 z Variance(# ) <br /> HOME PHONE CELL PHONE E-MA LADDRESS <br /> 241 ` % •i 111.816; drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME /I CONTRACTOR NAME <br /> /O`h LG ni b " Son /qrt/�e✓i Ic, �7h,r c,e to4, l e ite Plan including location <br /> A ENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> & fey,/1.Se 1 - ,/s 74- 4,"4u q' 1I)/' vq(9t14,State,Zip) (City,State,Zip) S acks <br /> VolDll PHONE V` / PHONE 1 I=1 Site P approval from <br /> 3.5° , / 2, (o i , .Z 3S- - / c`5(o 6 appl wnship. <br /> E-MAIL ADDRESS . (•,,E-MAIL ADDRESS <br /> r.) F or plans to scale <br /> sv„ f - A fi4 - .4 <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL UMBER: CURRENT ZONING: ACREAGE: E ation of property <br /> ElPARCEL rontage drawn to scale. <br /> NUMBER D If bs/©'0:14,).zr 7 R I P <br /> TOWNSHIP: SECTION: <br /> / 13 u k-e 3 , : ti./ 1414: ❑Drive ermits <br /> / ADDRESS: / l (Stat nty,town) <br /> �Yr 3537 Rie�l� C+, "Aeroords, 0 s3S 32 ❑Sanita\ •- its A <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 7 (pu• . , ■rivate) 1,� <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> STAFF REVIEW <br /> 2 S X 3 (p De /4c if eb( 6A✓✓!,3 -C oning District <br /> . This project is a new building or structure. ❑ rmitted Use? <br /> his project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEWER [EP11C (new/ <br /> ✓HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> f3 (711•6 Wetlan•► loos• ain/ <br /> Shor- - . ii.ttachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: Erosion % ' ro permit <br /> ,�— l 0 a 0.J 1 TOTAL SQUARE FOOTAGE: j (slop-s,di rbance, <br /> � filling/acre <br /> 2ND FLOOR: 3RD FLOOR: <br /> /008 <br /> eview Location Su <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ p Sf - '' available op : t .A <br /> (Please round to nearest dollar) 11 .� 3 3 V�, <br /> 0 c <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes �lo ElDon't <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes , o EDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes r o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Efres I o <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) Res go IJon't know <br /> 7. Is this to correct a violation? es o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-117(4/OAl <br />