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ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> II /144 ►'Vj ,L oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,Sta ,Zi) C ,��G (�� ` Deed Restriction; CSM <br /> 4 to ��ti fy C't>4y �V r �p Pr4 i✓1'G 5 Sc 7e2 Variance(# ) <br /> HOME PHON I CELL P ONE E-MAIL ADDRESS <br /> '%. IP Z Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME / CONTRACTOR NAME <br /> 1 Un') 1-fIni ko erS m to j l4y 6y,(4c•C /3r.,i'dee 5 Ian including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> /d 01 �`n fe'p��si� b✓'. s 7(. Linkizebc,/ 44 . <br /> (iCity,,State, ip) (City,State,Zip)/ acks <br /> V �e'o �t 5 3513 - �\h �/ -1) �r3 s r0 <br /> PHONE 1 PHONE Ian approval from <br /> 3 S - / e7 .. 3s . , B(v zc applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> t°41 tAe44 it.e ,lt tQh,OL /C0v or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: vation of property <br /> ❑PARCEL ��`` �`2 �(� ^ ex �� frontage drawn to scale. <br /> NUMBER v# owl• K <br /> TOWNSHIP: SECTION: <br /> 51',10 PeAIN (4_ —?r %: 51.J 1/4%. AA) ❑Drive permits <br /> ADDRESS: 6.= '' /I �� )) (stat , unty,town) <br /> '�T� L.V! 1> 4i . 1k' //s r'vl `e El Sanit: <br /> ermits <br /> CSM: ? LOT SUBDIVISION BLOCK/LOT (pub• , .rivate) <br /> eJ¢c2, <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: I' <br /> 2 L- 1 x L e E; t h Lq1 6e%vG yc Wing District <br /> . 21This project is a new building or structure. ermitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: raI AdsiteSS <br /> EWEREPl1C JS (nevrsi±� <br /> HEIGHT IN FEET: NUMBER OF STORIE ( of including basement) <br /> - 5 0 Wet nd/FI odplain/ <br /> Shore d (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: ❑ Erosio C trot permit <br /> j TOTAL SQUARE FOOTAGE: j (slop , isturbance, <br /> filling/a ss) <br /> 2ND FLOOR: 3RD FLOOR: <br /> —7 -)--� view Location Survey <br /> ESTIMATED ED CONSTRUCTION)COST: ♦ ♦ ♦ ♦ ♦ $ ��k and available options. <br /> (Please round to nearest dollar) <br /> The property is within 300 feet of a stream or 1000 feet from a pond or lake? es Lilo on't kn w� <br /> 2. Is there a wetland or floodplain on or near the property? Yes o on't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yeso <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ao <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) Yes 3o aon't know <br /> 7. Is this to correct a violation? Eyes o <br /> "40 APPLICATION MUST BE SIGNED <br /> s45-1I rcinPl <br /> (Continue on Back) -+ ♦ -♦ <br />