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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> tem z? L.L.c. ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,SVe t,City, e,Zip) 1 Deed Restriction;CSM <br /> gay A �n-on -to 8;117 ieDne, 144 S35e13 Variance(# ) <br /> HOME NONE CELL'PHONE,, E-MAIL ADDRESS <br /> At JA cgs •�°�a/ W I za ei'e a�01::' 6Oi 1 ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAKIE CONTRACTOR NAME ` <br /> WIe+M )4 4z- :_4:_ -j- Nor 0 u;1 ca 'rs ❑Site Plan including location <br /> AGENT ADDRESS __,..— % CONTRACTOR AD9VESS of well/septic <br /> 6A01-6 44 1 r►1\1 o 't .24-25 1<"e ict(Ali rk ►e. <br /> (city,State,Zip) (c1,qIat�iP) ' to ❑Setbacks <br /> PHONES PHONE v—� ❑Site Plan approval from <br /> 6657. (d3,. U��5 6n e,a; 77/, D / 17 applicable township. <br /> E-MAIL ADD ES r E-MAIL ADDRESS <br /> yy.�el el z 't -oaf/A, t.btm b an,e,Q"I�ri—no flh ,eO M ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 045,60b,4.,5-705,_ a <br /> NUMBER C 'COSY frontage drawn to scale. <br /> TOWNSHIP: t SECTION: <br /> Tutu's l�r1 26:61 Ci 1//: 1/4'/4: ❑Driveway permits <br /> (state,county,town) <br /> ADDRESS:3 i )d +Y'S 6 r►1rr11 eirCi t l Cevi =ee' <br /> CSM: LOT SUBDIVISION BLOCK/LOT ID(public, permits <br /> �� (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION/1: ._,. / gin sr Z e, 4/1,1' <br /> I2 Qb 0 5r p-unli%vezer.4 ►itl .1 Di+►I�i1G, ' worez4 o0vSL G>li�,►w�ce1 LI Zoning District <br /> . Jj This project is a new building or structure. J ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER [EPTIC (new/existing) <br /> HEIGHT I FEET: �� NUMBER OF STORIES: (Not including basement) <br /> 10 �(.� `j�d� O>iJ E LI Wetland/F000dplain/ <br /> AREA TO NEAREST SQUARE FOOT: i i ' '? <br /> Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and abo l'e grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> cog ig/�rL 17 ig ! TOTAL SQUARE FOOTAGE: I (slopes,disturbance, <br /> T �/7 filling/access) <br /> 2ND FLOOR: _FLOOR: <br /> is / Z/ °0 0 Z, O © � ❑ Review Location Survey <br /> ESTIATED(Please round to nearest dolll)COST: $ 8 06 633 41 and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ONo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes RN() ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? QYes ❑No <br /> 4. Has there been a zoning permit issued for this property in t ast 5 years? Elves •lo <br /> 5. Is this project associated with a rezone/CUP/variance petition appeal# 9 'I ') (leave blank if none) <br /> 6. Is a location survey required? (see reverse) [Yes llo ['Don't know <br /> 7. Is this to correct a violation? Efres RIO <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) 1 et/ • Z (Continue on Back) _ _ _ <br /> / <br />