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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVID <br /> /OWN NAME AR6T y Z/f V8Sr 1l-ien <br /> Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> eed Restriction;CSM g-©3U <br /> X89 U,4�F e',066 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 12Kite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENNTNAME CO NT CTOR NAME /UN vv✓7Ci4L -,•; r—LJe/Vad <br /> t5 A4d6-er4 [3/Site Plan including location <br /> AGENT ADDRESS TRACTOR ADDRESS of well/septic <br /> �l9 3 /9iepe.Lr��. <br /> (City,State,Zip) (City, tategip) fjjetbacks <br /> /11,r,o49G i✓ 4t1/ 536 Z /I <br /> PHONE PHONE psi e Plan approval from <br /> 1646.-g.3)_4Z Z applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> +, h 'e "'-r'L De A1011e Q t, ; C Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http a//accessdane.eo.danwie- .0 I) n ' <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: LyElevation of property <br /> 0 NUMBER bs8 011-3¢3-v5t3-0 b 7Z% frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> orkiiiu pieltiAi 1,4. 1/1/4: Driveway permits <br /> ADDRESS: (state,county,town) <br /> Z2- Zb 6Le / o.AZS 1-,,a 1 <br /> CSM: LOT SUBDIVISION BLOCK/LOT I�unitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> r AFF REVIEW <br /> PROJECTT DESCRIIPTII' <br /> / G�v �4Zg ri- - C /Q 7■-•66 �ni •s n_ <br /> , <br /> g <br /> . This project is a new building or s ucture. Permitted se? �" <br /> This project is an addition/alteration to an existing building or structure. � ,� � <br /> SANITARY SERVICE: PERMIT N MBER: -ilia'‘Rural <br /> a <br /> / - y� q the -r <br /> EWER ØEPTIC G 3'Z /(� C��/!,�'i a to <br /> HEIGHT IN FEET: NUMBER F STORIES: (Not induding basement) <br /> 2- akiW'''''?h- #oodplain/ <br /> Fiorel • attachment) <br /> AREA TO NEAREST SQUARE FOOT: n � <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ErOSIOt)COrltrOl permit <br /> / �� g ,/ 4, TOTAL SQUARE FOOTAGE: 4, (slopesrdisfurbance , <br /> filling/access 7i <br /> 2ND FLOOR: 0 s9 3RD FLOOR: 0 Z g � <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: / G—� . aridavatla�jeoptlons <br /> (Please round to nearest dollar) ♦ ♦ t ♦ E,t , _ ,:,. .,. . <br /> 1. The property is within 300 feet of a stream or 10001feet from a pond or lake? Ti< Elio Don't know <br /> 2. Is there a wetland or floodplain on or near the prop rty? QYes ❑No Don't know <br /> 3. Have you talked with the township about your proje t and are they in agreement'? [ S Q Jo <br /> 4. Has there been a zoning permit issued for this pro erty in the past 5 years? QYes ©No <br /> 5. Is this project associated with a rezone/CUP/variane(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) F ❑Yes ❑No Don't know • <br /> 7. Is this to correct a violation? .. Yes EjNo <br /> r ) (0 APPLICATION MUST BE SIGNED <br /> ///��, ' Continue on Back) —► —► <br /> 545-112(4/08) <br />