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- -G.Wk7-1, S2----t-S , --- - - S <br /> "_ ....t)' <br /> - ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> STM</ 1.---. Oc LY oning Status; CUP; <br /> JO WNER ADDRESS ( umber,Street,City,Sttatte,Ziip) `� �,{(� �J(J E K�f�V ADvE QaP11Q‘� wY 5610 Variance(#Iction; CSM ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS � <br /> •• -.' )-1 95 0% (.. - - :" • S l . . a u) erg' F7g - IJC, CQN\ �d Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ' t. .2.U+, C LL -' \3 JtLO A(p C,JR-Q ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> \9O 2x\61.1 "j--C. 3 3,4 LA 30 <br /> (City,State.Zip) (City,State,Zip) etbaclCS <br /> V2��, 5393 ��et � 3�9� <br /> PHONE PHONE cr I It Ian le approval from <br /> bog- -yo - o3a� l40 s � boo app "_ township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT •PARCEL UMBER. ^ 'CURRENT ZONING: ACREAGE: Elevation of property <br /> ] frontage drawn to scale. <br /> NUMBER lTIp (Alt-341-1c-lot-0 RNA- i a, � <br /> TOWNSHIP: SECTION: <br /> Q2 a�(Z, aa'g-1\ %: 1„,,,,, 1/a'/a: 1....1c . /Drive rmits <br /> ADDR€SS. Q �' (ss ,c nty,town) <br /> a-aa 1 �U� � �� 11� and rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> -1� (pu , rivate)■ <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 96 I-4 't\,4`--V) ) S'fo e 0 tf'-- X GL-1 Zning District <br /> . This project is a new building or structure. Lermitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NU BEER Ural Address <br /> Li SEWER SEPTIC \�J 1 (ne ISt1 <br /> HEIGHT IN FEET: NUMBER OF TORIES: (Not including basement)c� <br /> 3xI*"/ ' " 1 Wetla / oodplain/ <br /> hor (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) �� ionCo trol permit <br /> BASEMENT: 1ST FLOOR: <br /> ' l0 Q Q 4, TOTAL SQUARE FOOTAGE: 4, (slope - sturbance, <br /> 2ND FLOOR: 3RD FLOOR: D Q <br /> 0 Q flllln <br /> I o� -fr. Review Location Su <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ -► and available opti.• - <br /> (Please round to nearest dollar) ��,1��� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ,L,l__d,,//No ❑Don't know �) <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes L>dNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑,Yes L'Ilo <br /> L <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank i none) <br /> 6. Is a location survey required? (see reverse) ❑Yes /No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 2<lo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) — -• — <br /> 545-112(4/08) <br />