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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU TOMER TO PROVIDE <br /> OWNER NAME <br /> Rtck,b.L) 4 S4soft-x-� MCd--S6=(3626- LI oning Status;CUP; <br /> OWNER ADDRESS,(NOmber,Street,City,State,Zip) eed Restriction; CSM <br /> /v 20 /�(A 1n/1(i frufSG0A) 7 4) ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6ag-84-3 41 t g 641r-626-3 Q rn lo,Z, 4 6 vK -b20t 0'11.cc..� S' Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME r / <br /> §fte Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS ilif well/septic <br /> e-(City,State.Zip) i2144•1 (City,State,Zip) d3 Setbacks <br /> PHONE PHONE LI Site,P1e1sapproval from <br /> plicable township. <br /> E-MAIL AD RESS E-MAIL ADDRESS <br /> oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING' ACREAGE: Elevation of property <br /> krPARCEL <br /> NUMBER 02 8AX(O-342-"&34L-1 i hl .57-39) $:5/o-t c6f frontage drawn to scale. , <br /> TOWNSHIP: SECTION: ❑ DrIVeW p(pT�' <br /> �LI rrn.J N\ 'A: N F '/4%: ,,ay ermits 111��r <br /> ADDRESS /ROI (S ,County,town) <br /> -tc„.,.) , ,S 0•r∎ , ` �, <br /> ❑ Sanita, p f , <br /> ermits h <br /> CSM.7 4 0 9 LOT SUBDIVISION BLOCK/LOT <br /> (pupli6,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: Co(N 46 c� ST2vc-ru a /{�/fth Roc yis.o iu-c �a L F f3.,:,_p:,;� CD 0 / /0) al oning District <br /> ❑This project is a new building or structure. Permitted Use? <br /> LI This project is an addition/alteration to an existing building or structure. .f=' <br /> SANITARY SERVICE: ,r/�/vLL PERMIT NUMBER: ❑_ RU l ASs <br /> ❑SEWER v ❑SEPTIC ( ing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 2,0( To pEytk Gee etiand/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> St)6reland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) • Control unit <br /> BASEMENT: 1ST FLOOR ,' permit <br /> //'� TOTAL SQUARE FOOTAGE: (SI.r- ,disturbance, <br /> FLOOR;,... fi • access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> (.9 ISO S f di Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -+ ♦ -► ♦ —11. and available options. <br /> (Please round to nearest dollar) $ it,OlrCj <br /> I <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes A No LI 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? IA Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 54 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 j2ii No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes A No <br /> ` APPLICATION MUST BE SIGNED <br /> 545-112(4/08) # (0J :c) (Continue on Back) -+ -+ <br />