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'L.. • <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUS OMER TO PROVIDE <br /> OWNER NAME <br /> S-NA-e Le n v 01€ I I Zoning Status; CUP; /qtr nV1 <br /> OWNER ADDRESS (Number,Street,City,State,Zip) (� J ( Dee Restriction; CSM r <br /> 5`1.c0 .(.1bc._ Valley R ,Licc.uvtch -ee,�S 535-97I V lance(# \--P-16-) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS r` <br /> 'S' 7 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME I CONTRACTOR NAME <br /> I. (0 m ue 4 S ssdes Site Plan including location <br /> AGENT ADDRESS 1 CONTRACTOR ADDRESS n i <br /> t <br /> II/s p s <br /> (City,State,Zip) I(City,State,Zip) <br /> Jr r ( (y etbacks <br /> PHONE I PHONE Si' e Plan approval from <br /> ........fv0? _:...... y...`f...'..._3g._ _g a I' <br /> .................... Icable township. <br /> E-MAILADDRESS 1 E-MAILADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION htt Naccessdane.co.dane wI.0 <br /> p� <br /> PARENT ;PARCEL NUMBER I CURREN'TZONING: ACREAGE: levation of property <br /> J PARCEL p �1 1 r7 p frontage drawn to scale. <br /> NUMBER O(3D 1-273-7 90- Z 1 A -I LEXJ 8 <br /> TOWN HIP: SECTION <br /> j'en 2 7 -1/4: S(tJ -1/4'/: Sys eway permits <br /> ADDRESS: — — — (state, county,town) <br /> 5y50 Z.--c � Oci( , Rd. C.�4� ►..ckee. (J3 13 sic <br /> CSM 1 LOT SUBDIVISION I BLOCK/LOT nitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTI N: i /� <br /> Po 1 Lc.r'rt AT:ezi 4•}[, ,ntk 1 1'rteSse, 6“; jig li Li oning District <br /> A This project is a new building or structure. <br /> ermitted Use? <br /> U This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER r .r-,al Address <br /> J SEWER J SEPTIC ( (new/existing) <br /> HEIGHT IN FEET`. NUMBER OF STORIES: (Not including basement) <br /> U Wetland/Floodplain/ <br /> • <br /> • <br /> • Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) P <br /> BASEMENT: 1ST FLOOR - _ ❑ ErvsionControlpermit t <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) <br /> it 10 O ❑ eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ - and available options. <br /> (Please round to nearest dollar) 73,000, 00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LJ Yes . No J Don't know <br /> 2. Is there a wetland or floodplain on or near the property? U Yes H 10 J Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? eSies J No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? J Yes <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# none) <br /> pp ) (leave blank if non <br /> 6. Is a location survey required? (see reverse) J Yes 1\--10 J Don't know <br /> 7. Is this to correct a violation? JYes kf\lo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —►545-112(4/081 <br />