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ZONING PERMIT APPLICATION 4ww.countyofdane.com C1172“Cia.JJR4:,14:111SCilL.E1MLI-T11,41 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME L <br /> e 4 4j4 l 401 Cpl k?Ito�. 0Zoning at UP; <br /> OWNER ADDRES ,,(N�lumber,S refit,City,State,Zip) / , Deed Re riCtlOn;CSM <br /> 4g34/A l/44t6i,1 5cfriPrctro % 0 J~.3S ., Variance(# ) <br /> HOME PHONE CE HONE E-MAIL ACDRESS <br /> S ` )O ❑Site Plan r to scale <br /> AGENT INFORMATION j CONTRACTOR INFORMATION and includ s dimensions <br /> AGENT NAME CONTRACTOR NAME r1 <br /> Iii 411/i e''& i / er'/ccvt &t#ayr �.xri(i s El Site Plan in lu . g location <br /> AGENT ADDRESS CONTRACTOR ADDRESS ✓✓ of well/septi <br /> 12,74 Cil tent yvts>° 7)'. 6-2 Go 4094"4' 6,, - <br /> (City,State,Zip) 99 (City,Stat Zip El Se CICs•Chk 1 WI S' S'' 3 Syh #Vri t 0i 3 3510 PHONE PHONE , El Site PI n . ••oval from <br /> -R 3 s ` / 2) G' E ..2 3S ` r i .&'CJ appli.'li, ; t,-""• <br /> s ip. <br /> E-MAIL ADDRESS I E-MAIL APDRESS <br /> /n1?ti q,44 >C Lt Cq 4;l 0 Floor pla o scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevatio Of p party <br /> PARENT PARC NUMBER: CURREN ZONING: ACREAGE: <br /> '•C <br /> El PARCEL NUMBER " OOp 9.z` '-4- 4 ', frontage n to scale. <br /> TOWNSHIP: A y SECTION: <br /> ft( 5 t0 .2/ � : Al E %�: �0 ❑Drive .y • Its <br /> ADDRESS: <br /> Y (stag', .• town) <br /> &�3� M' • f(j4t6,.. ...340 Nfr-/e sas-5 0 ❑Sanit.ry its <br /> CSM: LO SUBDIVISION BLOCK/LOT (pU•1 I e) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: � <br /> I / <br /> 02 01 X .2 � b "r c h eel � a,95 L° ❑ Zonin D" nct <br /> . EiThis project is a new building or structure. <br /> ❑ Permitt e? <br /> This project is an addition/alteration to an existin4 building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ RuralA�ddr�es�s <br /> EWER E}EPTIC (new/e)ds4 �J/ <br /> HEIGHT IN FEET: i () l ' NUMBER OF STORIES: (Not including basement) �./ <br /> 4- . i�z Qh e ❑ Wetland/Flo lain/ <br /> AREA'TO NEAREST SQUARE FOOT: Shore! (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionCon permit <br /> 1�^^ j TOTAL SQUARE FOOTAGE: 4, (slopes, urbance, <br /> 2ND FLOOR: 3RD FLOOR: V I filling/access) . <br /> — ,� E(.0 0 Revi w i eY <br /> ESTIMATED CONSTRUCTION COST: (f / �y a`2- and a 81- • " ns. <br /> (Please round to nearest dollar) --► ♦ S / / Cb O. <br /> J <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes �lo aon't know <br /> 2. Is there a wetland or floodplain on or near the property? (es o Ion't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Yes Lo <br /> 4. Has there been a zoning permit issued for this proil)erty in the past 5 years? Efres alo <br /> 5. Is this project associated with a rezone/CUP/variarjce(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Yes o IJon't know <br /> 7. Is this to correct a violation? Yeslo <br /> I <br /> '27. ), l fJ APPLICATION MUST BE SIGNED <br /> {�/ (Continue on Back) <br />