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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 7 I tALODOCE F21 E O L Z Ing Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 1 t 6 Co A T-t (Lv F 0 P eed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE 1 CELL PHONE E-MAIL ADDRESS <br /> 08- .(Z: 6j 7 6o b. 2iZ 6917 -1-e.d ,f t I ea t e r m41 I i ,w Ian drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> C LFA�`� 8�Il_fl I�i�� S' Ian including location <br /> AGENT ADDRE CONTRACTOR ADDRESS of well/se 'c <br /> 190 PADL_I S T <br /> (City,State,Zip) (City,State,Zip) S aCICS <br /> vE2�NA , Wi 5353 <br /> PHONE PHONE Si an approval from <br /> 800-- -333-5.33 c applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> dle�,1 @ Cd ew. 1 id;fs, , corm Fl lans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING:G,a•3 ACREAGE: . Eleva •• of property <br /> PARCEL �O _'L‘l �'S -3 i{3 j f • .ge drawn to scale. <br /> NUMBER <br /> /0W NSHIP: SECTION: N c " Dr wa rmits <br /> U IZ t(A04:2;� ' '\ '/.: N '/a'/<: (stat ,town) <br /> ADDRESS: <br /> `11 W L Ci ix rl `I Qo .r R / O RE A O N I1 Sa p is //V,p �' <br /> CSM: LOT , SUBDIVISION BLOC OT (publi te) � <br /> 6•L'6 <br /> PROPOSED PROJECT INFORMATION SyCIFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 114 0000-- p Z E N A 4 S Tik■..t_ 6 Ac pJ 't 12*+,s o1 Wing • trict <br /> . <br /> This project is a new building or structure. P itted se? <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBS : R Addre <br /> EWER r)EPTIC n / ' ing) <br /> HEIGHT IN FEET: NUMBER OF STOR ES: (Not including basement) <br /> ZS I/3 M ` etl d/Flood lain/ <br /> I/3 �C p <br /> Shor attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ ErosionCo l •I •-rrnit <br /> BASEMENT: 1ST FLOOR: /� <br /> y�'� 4 TOTAL SQUARE FOOTAGE: 4 (slopes, • s urban -, � V,fl/// <br /> filling/a - <br /> 2ND FLOOR: 3RD FLOOR: ) <br /> '"_� eview Location Survey <br /> ESTIMATED ONSTRUCTION COST: ♦ _ ♦ All and availa options. <br /> (Please round to nearest dollar) <br /> Ye <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ®Yes Olo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? fres alo ❑Don't know <br /> 3. Have you talked with the township about your project aefiefe-they in agreement? .... DYes EINo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes flo <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) f Yes Jo ❑Don't know <br /> 7. Is this to correct a violation? Ores 'lo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545-112(4/08) <br />