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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CU-TOMER TO PROVIDE <br /> OWNER NAME <br /> C A ul Qwcr * I/JANfA So e.o c.o,.,s <br /> Zo ng Status;CUP; <br /> ,OWNER ADDRESS (Number,Street,City,State,Zip) ' D ed Restriction;CSM <br /> ?.124S tcht-B s.Q j 2.0 V riance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (00:- T79- 0120 /.SOKO 3gI • 4 .L .COW) ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION an Includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> /VEAL 1/ii£gc,4'i- s Mo2Z9N giA it.OZNC+r Zic ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> 4./// 0 Arket22.4 NV Sr \Nl 119a AlAtR]c x.✓Sr <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> I./to,J7A L 3.3 03Co j oN LA WI 53o3 (' <br /> HONE ` PHONE ❑Site Plan proval from <br /> `-1/4-/- 7/9- o8,23 gig-7/9- 08.23 applic etownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 2 / .w;e, eftj • M04/WN: I ea1.w;e.(Jelked►3 @ <br /> • ; S loo;plans to scale <br /> PROPERTY/LOCATION INFORMATION (httnJ/accessdane.co.dane.wi.us/) C evatlon of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: I IJ'�' <br /> ❑PA M�� <br /> NUMBER oJ09//-/(0/-�qq�/�+-S -1 /f (1 frontage dra n to scale. <br /> TOWNSHIP: SE7TI N: , <br /> SR�SSoc. '/4: iN E 1.4%.:_s-v.) ❑Drivew permits <br /> V /ADDRESS: <br /> (stat ,COU town) <br /> v <br /> '72S W3 ,JAP1 ZO ❑Sanit permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (pU IC,private) <br /> q7(01 i <br /> PROPOSED PROJECT INFORMATION S F REVIEW <br /> PROJECT DESCRIPTION: <br /> FA A^ STD(IA 6,E /StfoA &4t.0i/J6 - AG use C O'r/aO onin District <br /> . ,EThis project is a new building or structure. erm itted Use? <br /> ❑This project is an addition Iteration to an existing building or str c re <br /> SANITARY SERVICE: PERMIT NUMBER: 0 Rural Address <br /> EWER EPTIC U� (neW/ <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not i cluding basement) <br /> 027' "� QEA a /�`o'' ��� �.�5 1 D Wetland oodplain/ � <br /> (attachment C>r' <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) rosionCoritrol pe il <br /> BASEMENT: 1ST FLOOR: 7� O <br /> 4, TOTAL SQUARE FOOTAGE: + (slopes, • •= <br /> 7 filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 00 1. Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ Q� OO! and available options. <br /> (Please round to nearest dollar) $ a2 000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a and or lake? es o Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Jlo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Des ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 1lo <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 ErNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 2N <br /> APPLICATION MUST BE SIGNED <br /> sas-112(4/08) r, (Continue on Back) -♦ -* <br />