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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 /> I-Auu a.&JGE R. C7 Zoning Status;CUP; -3 <br /> OWNER ADDRESS (Number,Street,City,State.Zip) Deed Restriction;CSM <br /> 1 5of 8(zYAi WUc_P 1)R Variance(# )744 2 <br /> HOME PHONE CELL PHONE E-MAI ADDRESS <br /> 6 8-ZZZ-9?ll ! -2/7' 2S'ZE /acr ✓- a3 maLi (.cowl <br /> 0% Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions / b <br /> AGENT NAME CONTRACTOR NAME <br /> SKI-Site PI-I .icluding location y <br /> AGENT ADDRESS CONTRACTOR ADDRESS O i - • Pei- <br /> (City,State,Zip) (City,State,Zip) Z Setbacks t' 3/3 6 2.0 / <br /> PHONE PHONE gSite Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS , <br /> Ni Floor plans to scale ///��t/e/ <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usO -Elevation of property // <br /> Ap <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> El <br /> PARCEL 05o`o9o7-01 1.$osf-$ R)4 3 9 10 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP. SECTIO : rr ( N e/elf <br /> Tow.•f of got.8cat2.y 1 ❑ : N 1= ❑❑ : /= D ivewaypermits / ! iC <br /> ADDRESS: ( Y. / ,/ <br /> 791'- B OVJ/NA iN R.D /ti.c+-t, <br /> Sanitary pe nits <br /> CSM: - 2 LOT SUBDIVISION BLOCK/LOT (public 4412M <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ,3 �1 Z <br /> flora Se ANti P \u E 1A-3A H CAD 0,3S ed—LACI'(0iJ,6C P-- -rtpELL Zoning District �� <br /> This project is a new building or structure. ,,Permitted Use? Fg <br /> ❑This project is an addition/alteration to an existing building or structure. No O v-p lcx <br /> SANITARY SERVICE: PERMIT MBER: , Rural Address � <br /> FTEWER tEPTIC 13 B z o )G — 0002 9 �!existing) y r <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) /11G,g r g W` : ...4 oodplain/ <br /> , ( ttachment) <br /> AREA TO NEAREST SQUARE FOOT: /V v _c/W _` HV' - <br /> (Outside dimensions in u ing unfinished area,attached garages and above grade decks or porches) ,EroslonCAntrol permit <br /> � T <br /> BASEMENT: 1ST FLOOR: <br /> 41-.1410 (O � 3 ' 8) I TOTAL SQUARE FOOTAGE: 1 (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) Sc 2Od 6 <br /> 2/ 56 St Review Location Survey 0 2G <br /> ESTIMATED CONSTRUCTION COST: $ L .r (900 oo and available options. / <br /> (Please round to nearest dollar) 1 j <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ®Yes ON° 0 Don't knowC W L <br /> 2. Is there a wetland or floodplain on or near the property? [Yes EN° ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes fNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes QNo <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 ENo QDon't know <br /> 7. Is this to correct a violation? Eyes SW <br /> Ile kit/ I^ S j= g- Not 01-P I C 0C <br /> cYC (af Q �' j APPLICATION MUST BE SIGNED <br /> 545-112(4/08) z _/ fy No F 2 e / c G Pt--- --7`C."� (Continue on Back) = - - <br /> )-(3-/4 Alosq-ir a <br />