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. _ q'IN1(4 b---19-0-1- Po i.A <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Di Ct CI All Se AN Ae 2-0.-6,'►1S 1�■ Er(: _Status; CUP <br /> R ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> qyLIL( J. IAA I&X jk1+t... Pb1 MT i VAT \-to(z_E u , V4.1. 53 5 `0-- Variance(# ) <br /> HOME PHONE 1 CELL PHONE E-MAIL ADDRESS <br /> b0& 37=a H (Pc D YJ Z<�R�,'11S k1 G.F AV i I°►ff.�. i 4t..” ' Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME —146--Art- F Q2 Ye-xi-2_0i 1,W4PONTRACTOR NAME <br /> t VE DOL,AeiN 1 t�t14A)Rti4L.T40 tVI -1 L t33) ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1 719 F O--S 4 T 4 i'ALV <br /> (City,Stat , ip) (City.State,Zip) Setbacks <br /> ST, t-UU1s vbl4 b3t0S ,/ <br /> PHONE 1 PHONE l'Site Plan approval from <br /> 31LA -'lab--a ko Ip applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS IOOr plans to scale <br /> adz lay)R ':r-f 14IWtsua • Cam.;v, p <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: allevation of property <br /> PARCEL '10-1 3� A _1 -- +0 2G 1 frontage drawn to scale. <br /> NUMBER 6 - �Z—itx�-� aid <br /> TOWNSHIP: O-IV-i-'3L Z,A4ZV.-I SECTION: <br /> C tZUS?1At 3r '/a: Li 11J '/a'/a: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> C{144 4 VJ,VIA itgb-itAt„ NI Cr ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> `k L.1,-)j>✓ -R. TOWER -Ve tz tZ uAJ VJ 1 tz Lc aS ❑ Zoning District <br /> . Ci"rhis project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 1'4 4� �txpf;✓►dwt7lt 4-t, tb <br /> 4-t, 0`) ❑ VVetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT 1ST FLOOR: <br /> TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $1, 'J \41)0(1 . MI <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Colo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? UYes ' io ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Ca's'es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes E'No <br /> 5. Is this project associated with a rezone/CUP/variance etition ppeal# °IcAlt3 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Ca's'es ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes C to <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />