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.,- -.1-. 4 2-6 liv4,4? ,0,R' ww."-t. s-ayi . <br /> .ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> • PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME L I U `� ' 1 <br /> 3o►` 1\ U i 1 III v���� IN, ) i'L (,( Li Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) pp M Deed Restriction; CSM <br /> (O L'q SUN (e- RC• 1-Ynf'5 11 L) L 51556c Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> a01 —655 -• I& LJ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AG NT N.ME ,, N�COONTRACTOR NAME <br /> 0J...,r .� O V. I r 11/ 'k, Ii <br /> i _c u A. _ Li Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS ` of well/septic <br /> 1z 1/3451.; - a' <br /> (Citya ,Zip) J (City,State,Zip) j Setbacks <br /> X40 A (A)-1. X370`3 <br /> PH NE PHONE Li Site Plan approval from <br /> &O '---23o__ z. 5 applicable township. <br /> E- `ILADDRESS 1 E-MAIL ADDRESS <br /> I11,, ha) , w. AL` I .PA __I Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: 1 ACREAGE: -I Elevation of property <br /> PARCEL <br /> UM EL (Dec itl/ �a C _2 1 .3b, ,7 frontage drawn to scale. <br /> NUMBER (� -1 6 <br /> TOWNSHIP: y/Sr S SEC? , 1/4:1 : S . '/1h: _ Driveway permits <br /> —. (state, county,town)ADDRESbh Yak 6r/K)� T RN <br /> L Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 11 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTI <br /> f c ..r� `� J Zoning District <br /> 'Y This project is a new building or structure. <br /> J Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. �7 <br /> SANITARY SERVICE: PERMIT NUMBER: Li Rural Address <br /> J SEWER LI SEPTIC (new/existing) <br /> HEIGHT IN FEET: ree NUMBER OF STORIES: (Not including basement) <br /> J Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ,-- �O ❑ (slopes,disturbance, <br /> permit <br /> 4, TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR. <br /> 3 w�-�On filling/aCCe <br /> �!� P Review Location Sur;ESTIMATED CONSTRUCTION COST: Q and available options. <br /> ♦ -o. -I. ♦ <br /> (Please round to nearest dollar) $ z o/000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? J Yes LNo J Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes "No LI Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Li Yes U1No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 411N o <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) U Yes M No J Don't know <br /> 7. Is this to correct a violation? ❑Yes LNo <br /> `- Cj i t\Ic LE- 3 t Eb e3' S./i'T APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> SIG (Continue on Back) -♦ -► <br /> 1‘ <br />