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0-----7,.; <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> jrte - tide -1 0eos jfiZoning Status; CUP; <br /> OWNER ADDRESS T(Number,Str t,City,State,Zip) <br /> 1 Deed Restriction; CSM <br /> (,76 Cou.n y d Niel D/�c aci Variance(# ) <br /> HOME PHONE CELL PHONE E-M I ADDRESS <br /> 0 3c'3I / rhq Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION .nd includes dimensions <br /> AGE-44+NAME C TRACTO NAME <br /> ICtry k. L. 4 .,,,_,z. �,,... orf ( p_ C.),E"c Site Plan including location <br /> AGENT ADORES 6,Lesic— CONTRACTOR ADDRESS ( ( \of well/septic <br /> (City,State, 'p) (City,State,Zip) Setbacks ir 6-37/i <br /> PHONE PHONE Site Plan approval from <br /> CO8 7 q T ?73 y applicable township. <br /> E-MAIL ADDRESS // 1 E-MAIL ADDRESS <br /> "jFc1'.• /1vo,... Cow.. / c o..' 4r+ '^of door plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER:')�/ CUR NT ZONING: ACREAGE: �� p p y <br /> ❑ <br /> NUMBER 63G92 v7 O 9302 3 p frontage drawn to scale. <br /> TOWNSHIP: SECTION <br /> O 1/4 S �1 1 N W/ Drive y permits <br /> ADORES st e, c unty,town) <br /> C70 C`°" a�r / e4a 1/11 ani permits <br /> CSM: /,� 3 LOT SUBDIVISION BLOCK/LOT ' (p IC, ivate)/PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> lee Q /t/, /6 r- o iQ <br /> C11 �,,, 12 Zoning District <br /> . ❑This project is a new building or structure. Permitted Use? <br /> NThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PER MI Nd E <br /> 1P—Rural Address <br /> EWER EPTIC I�i...'•�L� ` 1 <br /> HEIGHT IN FEET: NUMBER STORIE�: (Not including basem- t) �.1�Y18Tland/Floodpl.1-611 <br /> r° <br /> oreland (atta <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) C <br /> BASEMENT: 1ST FLOOR: rosionCont '. per <br /> 1 I—) 4, TOTAL SQUARE FOOTAGE: 4, (slopes, s•= urbance, <br /> 2ND FLOOR: 3RD FLOOR- flllln cess) <br /> ----- -\\Q <br /> evie oc ' n Survey <br /> ESTIMATED CONSTRUCTION COST: (� �3 )/ and av ' e options. <br /> (Please round to nearest dollar) ♦ ♦ --i ♦ -► tl \ <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 property? ❑Yes ❑No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes Elo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes ENo <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) Des No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -+ -+ <br />