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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CU•TOMER TO PROVIDE <br /> OWNS E <br /> o r c i+Ita� 4-�� f SpS n o -sk; 7 Zo ing Status; CUP; <br /> OWNER Number t,City,State,Zip) <br /> 7s-e-' / f D ed Restriction; CSM <br /> .e ° I V riance(# ) <br /> HOM HONE CELL PHONE E-MAIL ADD ESS <br /> 0I, - 2)7-- `® e Qi vcr, faO' iC AG lac■ •(DM, Si Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION a d includes dimensions <br /> AGENT E CONTRACTOR NAME <br /> r~ - j �,,-.4,/ i9(i;i L to Plan including location <br /> AGEN ADDRES CONTR TOR�DDRESS / f well/septic <br /> (City,State,Zip (City,State, ip) � � ���� Setbacks <br /> s %hoc GJ,f S757o Si Ail <br /> PHONE f- �,�� PHONE ❑Si Plan royal from <br /> af/'-d ? ,.i ��,L plic e township. <br /> E-MA ESS E-MAI ADDRESS <br /> ,'rail e - •. , Ltp 'i sarn�- loor plans to scal <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation roperty <br /> PARENT PARCEL NUMBER: CURRENT ZO/NII G: 7, ACREAGE: <br /> NUMBER 032 O!08 -213—1 U-7(y O /mil I �, frontag raven t Cale. <br /> TOWNSHIP "77 SECTION: p ' 1 <br /> dl Q , , ❑ Drivewa ermits <br /> �'%' _A........4,4 (state ounty,town)• <br /> ADDRESS: �- , '/' —�� <br /> 2 fl (C r ' oi.�"i- Jet vc' ( �'37 �3 ❑Sanitary rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> �J / , o , f ,f .(publi ,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTI(ply CCC/ ^ /� ?4,3 Q,1 <br /> lalIhis project is a new building or structure. Permitted tse? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE PERMIT NUMBER: Rural <br /> EWER PEPTIC 0n_ xistirrg} <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> /------- 0 wetcan7i plain/ <br /> Satlachm <br /> AREA TO NEAREST SQUARE FOOT: i10Fela ( <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ❑ ErOSionCpntr Brit <br /> BASEMENT: 1ST FLOOR: <br /> 1 TOTAL SQUARE FOOTAGE: 4, (slopes,;di rbartce, <br /> 2ND FLOOR: 3RD FLOOR: G` j/' _ 11ngia ) <br /> `IF v CI Review Location Survey e <br /> ESTIMATED CONSTRUCTION COST: G�J 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? ❑Yes MNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No EDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Efres ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? E]Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (le a blank if none) <br /> 6. Is a location survey required? (see reverse) es ❑No. [ Don't know <br /> 7. Is this to correct a violation? Efres ZNo <br /> 1 7 sun . —. APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112 0108) 0 <br />