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z__ 5 '' Iv <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> i\ LLG 61 mE.A)N . 1 JULIE 61 6g_DES oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 3q15 1-I4 l'FgSoi,I , ,D.i 51 oiyro&) lv I 5 S Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 5314 ' l S; ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME 0 LSO p)DLS, LLG <br /> $RMD F) l JF>J 0 t... lv toILS Li iUf Sc>rplI%1/NC. ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> —' q; ScH►u'Tz D. - <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> 5 /14/010//i AV) r /0 S-;5-6 Z <br /> PHONE PHONE Ite Plan approval from <br /> —__, 6OS - 809- /LiD ( applicable township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> ---- •f'ACI 0 01 SCWI GU I Its -cA9Yi1 ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us') evation of <br /> PARENT PARCEL NUMBER: �n CURRENT ZONING: ACREAGE: property <br /> ❑ NUMBER d V06/0- 7c!-$C1 J_' F- 1-4 i l N frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> DUAnO Oh 3S '/a: ga %IA: A - kVA %rivewaypermits <br /> ADDRESS: <br /> (state,county,town) <br /> ;q1; 14nLUf%25CJ1/4) i2P- A t-- itary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT '+ ` iUbIIC,private) <br /> N)9- <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ( <br /> /A)G/ v/JD SI J)f'LwmA FtL_ 7,o'-4 , zoning District <br /> EiThis project is a new building or structure. ermitted Use?'' <br /> ❑This project is an addition/alteration to an existing building or structure. R/ <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural ' +.`"-,,, <br /> ❑SEWER SEPTIC (new/'xisti ' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> "Imo- rid etiand/Flaodpiai ltn/ <br /> l AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ErOSIOMMINTOI permit <br /> rm <br /> BASEMENT 1ST FLOOR: V 4 TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) <br /> eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ( and available opt <br /> ions <br /> (Please round to nearest dollar) —0. '0 -0 -0 "0 -0 $ 5 V Q t <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes ❑N, ❑Don't know <br /> . <br /> 2. Is there a wetland or floodplain on or near the property? 7�� Yes Ni‘' • ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? .... ❑Yes ®.No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑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) (9&s ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) ♦ —► —► <br /> c.., <br />