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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 /> 0e-r t-1 D Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) .� Deed Restriction; CSM <br /> /663 CYYPR35 7 1`'fllavt TN „ 356 Variance(# ) <br /> HOME PHONE y 'CELL PHONE E-MAIL A RESS <br /> 82-7 ")48 0 1 (&43) ,35 `7O 143 3 / LM 'Ga-, ®Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> A coo ,v4QS Q Site Plan including location <br /> AGENT ADDRESS ; CONTRACTOR ADDRESS of well/septic <br /> ■ Pe) So k 5 ee 0 <br /> (City,State,Zip) (City,State,Zip) w' �31, > ID-Setbacks <br /> PHONE [[PHONE -81fe approval from <br /> e 8. ,133 -61 Z$ apply a le tow ip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS t-t-' <br /> 1 A /. P erideimrhesi orE Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CUE ENT7NING: ACREAGE: Q Elevation of property <br /> PARCEL 0607 / 8020-0 frontage drawn to scale. <br /> NUMBER �✓`'�r <br /> TOWNSHIP: S CTION: .- <br /> ,5PrhJb,p61-0 1/4: '1/414: l-BrtVeway permits_. <br /> ADDRESS`__ (state,county,,townil <br /> 7 2S L�cl ,1 Y n <br /> CSM: LOT SUBDIVISION BLOCK/LOT � publi ermits <br /> / 8 2 (publi riva \, <br /> _i <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> NEW /)eMf ❑ Zoning District <br /> . TaThis project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 1 Address <br /> EWER jPTIC l,3-- d O/ — -c.. ,4-VC (ne isting) <br /> HEIGHT IN FEET: t / YY ''/ UMBER OF STORIES: (Not including basement) <br /> / —9 /' / ,S751d�r ❑ We d/FI dplain/ <br /> Shore) attachment) <br /> AREA TO NEAR ST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) fl i' <br /> Erosi on r mit i <br /> BASEMENT: 1ST FLOOR: �� <br /> a®/ (0 2o7(e C)SS 4, TOTAL SQUARE FOOTAGE: 4, (slop s,disturbanc <br /> fill glaccess) <br /> 6�12es6� 2.- ± 1-, <br /> 1 <br /> �acz.c�,eeR: ___ <br /> ` 5/ 63 I 0/Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ 1 L n y and available opttns. <br /> (Please round to nearest dollar) -�(I(J/` \ // � <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ►,',o ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes ElNo QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? 2fres QNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes qio <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) QYes �No ❑Don't know <br /> 7. Is this to correct a violation? QYes 2No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(aioe) (Continue on Back) - -► -+ <br />