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ZONING PERMIT APPLICATION www.countyofdane.com (SUPPLEMENT-toWel>~App#.;. <br /> PROPERTY OWNER INFORMAT.ION*"?; t I'?t - `_ ", !, : x r . CUSTOMER TO PROVIDE <br /> OWNER NAME R 1/L- <br /> tcLter :0, r` -TR X Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) J Deed Restriction;CSM <br /> 6593 13A z>°r Rol Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6°E2-e36-7 , 6, i i-?- 79)3 c 0 \c r ' . ' ' c S . 1.1 6-- Site Plan drawn to scale <br /> AGENT INFORMATION _ `.3. rte ia%::.,. „? CONTRACTOR;;INFORMATIONASVMNi and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site Plan including location <br /> AGENT ADDRES CONTRACTO' •'DRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) 24 Setbacks <br /> PHONE PHONE .® Site PI nap oval from <br /> applicabliiinship: <br /> E-MAIL ADDRESS E-MAILADDR -S <br /> Nt Floor plAto scale <br /> PROPERTY/LOCATION:INFORMATION ;(httpa/access lane Co Bane wi.usn! Elevation of property <br /> PARENT PARCEL NUMBER: �J CURRENT ZONING: ACREAGE: P P rty <br /> ❑ <br /> NUMBER °S0 2 -364- bif30-Q p- /e )- , )- frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> S or; t,,`e (o� 6 1/4: !U W 1/41/: A)Ni &I Drivew°y ftrmits <br /> ADORE S: S Q� // (state, dt5t ,town) <br /> 6 S 93 ►JG/-2rr Ri -I Sa 'ary ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (publi vate) <br /> 06 • — <br /> PROPOSED PROJECT:INFORMATION. _ ,x. c -^1:": .:t..i ..a:'_".raginV. STAFF REVIEW <br /> PROJECT DESCRIPTION: / <br /> /4 d01n 4Q ex.s4;) 51-Nrec,?l )( ) Zoning District <br /> ❑This project is a new building or structure. 1 24'. Permitted Use? - <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT N,^U!MB j: ..1 ' <br /> ❑SEWER .2 SEPTIC (VIP/ /1 � <br /> HEIGHT IN FEET ( NUMBER OF STORIES: (Not including basement) ';.:4'.. 4:11b4'� � ��`��f <br /> Wa1I Al Peak=� 1 ' a �® � <br /> AREA TO NEAREST SQUARE FOOT: pF q�,410J. 001 1� ' .:s <br /> 1(Outside dimensions including unfinished area attached garages and above grade decks or pdrches) i71 , �� <br /> 0 <br /> BASEMENT: 1 ST FLOOR: �" �' � <br /> t <br /> 16xa4 r J Q� t r 4, TOTAL SQUARE FOOTAGE: j, ,- <br /> 2ND FLOOR: 3RD FLOOR: <br /> s , `` _L <br /> ESTIMATED CONSTRUCTION COST: x Q ® e 1i �: <br /> (Please round to nearest dollar) ♦ ♦ ♦ ..► -4. --► $ �� 660 -�S, 6o C7 4 ;-: 1 - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes 11No ❑Don't know <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'? -EtYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Jj No <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 'IA No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes §it No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4. -► <br /> 545-112(4/08) <br />