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f <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> G°4'4.'at'i1..41-' c.q. `e. L_:M. oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> V� Deed Restriction; CSM <br /> I^�''--t°=. t—„,,...t„i' cF,ir„.4p-sdp Rcw 17--n Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Gam•El M9. 19.1-* Cs • Vic,.isis9 41484(CaPtA4r"414146a et-C •' Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 1FI,,,,,.eate-t r 61.9+411..c.130.4 %AA 'F12'1s•' r Cm..-losT *"'' �.t.e._ ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ' c -te- C n rve.t.a� vb e_ "t +Z c — ' - . <br /> (City,State,Zip) (City,State,Zip) El Setbacks <br /> V .3 4. Ju-La j w% 1- 5`t L.e., wt 9S59.5 <br /> PHONE PHONE ❑Site approval from <br /> f . i • "2-c-,• <br /> c=. Come) 2.9e) •Co°47,Ce ap ca township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> k,FAeAir-+tr,elkd.-fAr6e-tr,y, u.w,,c-,. te,,-a. ,t e.,r044,-,rlesol s o• Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) [�✓Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 46°I Ck�3.S. Cil' I-- L'C'''_\ i9�")O t frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 1 .E '33 '/a: 5� '/4'/: sVJ El Drive yp its <br /> ADDRESS: (state nty,town) <br /> Co'fi,e=. wa% ->rwr'b.Fa-c-s> <br /> CSM: LOT SUBDIVISION BLOCK/LOT anitary permits 0 <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> - e /v4tt ,Etaw )OX 0 lit oning District <br /> . ViThis project is a new building or structure. 4.9 rmitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: D Rural ' 'dress <br /> EWER rEPTIC (ne - +•. <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> fib- '-te, `(-• 3( I I ❑ Wetland/Floodplain/Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: rOS10nCOn �=Tllt +TG� <br /> (�oG SF 1 TOTAL SQUARE FOOTAGE: j (slopes, •Isturban <br /> fillin► . • <br /> 2ND FLOOR: 3RD FLOOR: a7),4 <br /> SAC Q P -eview Location Survey <br /> ESTIMAT D CONSTRUCTION COST: and available options <br /> (Please round to nearest dollar) '♦ ♦ ♦ -■ ..1�P gr� . a <br /> I <br /> ❑ I t* <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes No ❑Don't now <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? E Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes Llo <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) ViYes ao ['Don't know <br /> 7. Is this to correct a violation? ❑Yes `at' o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -i <br /> 545-112(4/08) <br /> ,RE: 91,7,'y3,v,_ <br />