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Ri4 No <br /> • il ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWNER NAME <br /> C ^ l <br /> [ <br /> i'M C1'-f eorn IJ Zoning District Co 3utp <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> qsq/ ay, #4,y, - 4 Pi:t;✓,,G to 53590 ❑ Permitted Use? <br /> PHONE E-MAIL ADDRESS <br /> (ooh S3y-Z93 Co <br /> ❑ Zoning Status;CUP; <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Restriction;CSM <br /> AGENT NAME CONTRACTOR NAME Variance(# ) <br /> 6rieomJ 1J 41.53174/em uG <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> ill 300`Air Plan drawn to scale <br /> /(1 <br /> (City,State,Zip) (City,State,Zip) and includes dimensions <br /> `72, SE_ izzvLsTh <br /> Ck'"l aI1j 41� j2f ❑ Site Plan In oca ton <br /> PHONE PHONE <br /> 60- 220- Moto of well/se tic <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> \etbacks co()Carl�of ,0 Aild I .4a� <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Site Plan approval from <br /> PARENT PARCEL NUMBER: Z NIIG: ACREAGE: <br /> ❑ PARCEL L� 9 � c-( 42 <br /> applicable township. <br /> NUMBER .,.�7/ OS(1-.s 3' ( �)?� <br /> TOWNSHIP: SECTION: <br /> Sv,( eoa n;L 33 %:At 4,est_ IRA:�yi4, - ❑ Rural Address <br /> ADDRESS: v - (new/existing) <br /> 95-9/ Cdy. I . 7r Sr,h P13i i / 44 5-90 ❑ Floor plans to scale <br /> CSM: OT SUBDIVISION BLOCK/LOT <br /> ❑ Elevation of property <br /> PROPOSED PROJECT INFORMATION frontage drawn to scale <br /> PROJECT DESCRIPTION: '/ <br /> &Iry E '� 14 _ "g,. /x '(D i - ❑ Driveway permits <br /> ❑This project is a new building or structure. (state,county,town) <br /> 4jhis project is an addition/alteration to an existing building or structure. <br /> ❑ Sanitary permits <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> ❑SEWER CI SEPTIC <br /> (public,private) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> (LjQD + TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 1140c, <br /> LI Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ 0 00101" <br /> 01 a and available options. <br /> (Please round to nearest dollar) i <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 0 No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes MNo LI Don't know <br /> 3. Have you talked with the township about your project? X1 Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ll No <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none))t <br /> 6. Is a location survey required? ❑Yes ❑No u Don't know <br /> 7. Is this correcting a violation? ❑Yes X1 No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(1/08) (Continue on Back) ■ ■ —► <br />