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0oSfx , 47S0 5•�.g' /-- 5 �0 <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> A , .. ;03 <br /> PROPERTY OWNER INFORMATION Cu ••MER TO PROVIDE <br /> OWNER NAME Y Np ,( <br /> � r�G1� ""l ❑ Zoning Status;CUP; frit .� <br /> V OWNER ADDRESS (Number sheer cy State,zp) Deed Restriction;CSM 1^c!d l � 445C Ste_ / iL Sax (.OJT 53 `� variance(# ) it.�, <br /> HOME PHONE _ CELL PHONE gyp, E-MAIL DRESS k,„ <br /> 251-', 2' T J7I '�'° - ' i �°- #kfr _met de lan drawn to scale <br /> AGENT INFORMATION 1 CONTR:ACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRA•TOR NAME <br /> e Plan including location <br /> AGENT ADDRESS CONTRACTOR AD ESS of well/septic <br /> (City,State,Zip) (city,state,Zip) LLi�etDacks <br /> PHONE N PHONE Ire PI approval from <br /> app' bl ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> loo-plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLusl) levation of property <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: P p y <br /> PARCEL oe/a.,aa�, s'�-3 fr,I, 0 ��� frontage drawn to scale. <br /> NUMBER d <br /> TOWNSHIP: SECTIO : C� <br /> °GQg ova '/4: Q H 1/,1/.: 102 , rive rmits <br /> DDRES (sty'town) <br /> 3)4 .7 1V\ S SO u v.. permits------____f,Sanitary permits _p, I <br /> SM: LOT SUBDIVISI N BLOCK/LOT (publi.1• I vPF <br /> PROPOSED PROJECT INFORMATION / ..i‘o,...4 <br /> STAFF REVIEW <br /> PROJECT DESCRIPTION: ,/ <br /> of s e DE'c_l� Zoning District r~p <br /> c� i <br /> ice+This project is a new building or structure. 'flied Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMITNtj1MBER: RuralAddress /' <br /> U SEWER SEPTIC /9-6/z. <br /> / �COC xisting)1� ' c <br /> HEIGHT IN FEET: NUMBER F STORIES: (Not including basement) _ ' 3/ <br /> a/ A >ro — 1 Wetlancnl"loc dplatmt/ <br /> J horeland (attachmen <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached gages e grade decks or porches) <br /> c9/ ErosionCantrot 't <br /> BASEMENT: I4 1ST FLOOR: I TOTAL SQUARE FOOTAGE: j (slopes disturbance, <br /> ♦ <br /> + fitlingiaccess) <br /> 2ND FLOOR: 1 s60 d 3RD FLOOR: 67C)-S. // Review on Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ -I. and a options. <br /> (Please round to nearest dollar) eqi0.0 OOO <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the prop4rty? ❑Yes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 171Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ANo <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 igi No LI Don't know <br /> 7. Is this to correct a violation? ❑Yes 54No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► <br /> 545-112(4/08) <br />