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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Welat•App# <br /> PERTT'OWNEi 'INFORMATION . , x , ,. -; <br /> CUSTOMER TO PROVIDE <br /> owNER NAME <br /> J A v M e s / C A L Zonin Status; CUP; <br /> U,:i'N.R.ADDRESS (Number,Street,City,State,Zip) g <br /> fie Ai t //Q. k u� C-ipol (__ 1 1 , t Deed Restriction; CSM <br /> `�J p Yl tJrl�j G�tJ Variance(# ) <br /> HC∎ME PHONE 76e <br /> ELL PHONE E-MAIL ADDRESS <br /> g 6 -3 L l- ffe-Plan drawn to scale <br /> AIOEN INFORMATION`S' ''C .x 1°'4'' '':` CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CON RACTOR NAME <br /> - -)Li; -A-3 i--74 rit=4'.. ..1' '/i i /(i-- GUe a Pe©L s Eagife Plan including location <br /> 1-\61-_NT ADDRESS CONTRACTOR ADDRESS I of well/septic <br /> 313/g etvivi-Lillx 14413 <br /> iC,t, State.Zip) (City,State,Zip) etbacks <br /> _ <br /> 4440(SOP/ L 3 7/8 V���"' <br /> S <br /> r ,�r PHONE ❑Site proval from <br /> (,9z)0 -2,2-2 --17 appli le township. <br /> E MAL:.ADDRESS E-MAIL ADDRESS <br /> di"Aek i4ett/P// u(}11- ❑ Floor <br /> N to scale <br /> ,,PROPERTY/LOCATION INFORMATION"• (httpJlaccessdane,co.dane,wi.usf <br /> PARENT PARCEL NUMBER: CU. RENTZONING: ACREAGE: ❑ Elev�g r 6iproperty <br /> 1 PARCEL 02, / '1-D�t3-9037-a / _ / �- fron e`drawn to scale. <br /> NUMBER <br /> Tc.VNSHIP , SECT <br /> T L4 & Ik) i ❑ Drive a ermits <br /> 1 J I '/4:S �J '/4'/4: <br /> ADOF?r_ss (stat ounty,town) <br /> //25-DvA34;ek lave �o05ri.,r6 &,.l, w/ .555'B9 <br /> CSM LOT SUBDIVISION BLOCK/LOT El Sani ermits <br /> (pu ' , private) <br /> Y\ <br /> 'PROPOSED PROJECT'INFORMATION'"' <br /> STAFF REVIEW <br /> PROJECT DESCRIPTION: �,�� ,. <br /> O X �D ..1iV q1 /e D[.�4Jcd �jt.tbr 44 rV J l �"c)b L._..._ ❑;Zoning District <br /> . AT his project is a new building or structure. DiSermitted Use? <br /> (This project is an addition/alteration to an existing building or structure. r. <br /> ,ANI VARY SERVICE PERMIT NUMBER: Ulf-Rural Address <br /> EWER EPTIC (neW XIS n r <br /> hEIGHT IN FEET: NUMBER OF STORIES: of including basement) y'"" <br /> 7 A - -•• loodplain/ -- -r, - <br /> .� - Shore'. • P .chment C i ' <br /> AREA TO NEAREST SQUARE 00T: -.._ _ <br /> (Outsiue dimensions including unfinished area, attached garages and above grade decks or porches) <br /> -AL 1EN I: 1ST FLOOR: ❑ EroslppCo of permit <br /> ( C! 4, TOTAL SQUARE FOOTAGE: 1, (slope . Isturbance, <br /> fill' accss) <br /> ND FLUOR 3RD FLOOR: i <br /> ___ �,� Review Location Survey <br /> ESTitl4ATED CONSTRUCTION COST:' $ �"5/Doc` e'd and available o(,itions. <br /> (Please round to nearest dollar) --► ♦ ♦ i J \ ! <br /> i The property is within 300 feet of a stream or 1000 feet from a pond or lake? nl'es [No Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes [No kli ron'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 f NoG`6 J1 k'ioO <br /> 5. is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> o. Is a location survey required? (see reverse) Ekes ZiNo UDon't know <br /> 7 Is this to correct a violation? [Yes [21No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —r —► —r. <br /> ,.L151 <br />