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. (toc9, ie9 I. Li 79 <br /> ZONING PERMIT APP !CATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 1l i.Ke 77 -t al/Zoning Status; CUP; <br /> OWNER ADDRESS (Nunlber,Street,City,State,Zip) Deed Restriction;CSM <br /> y/4 6,11 10> /ALE- /1/144,4104, wi CT 7/ii Var nce(# ) <br /> HOME PHONE v CELL PHONE E-MAIL ADDRESS <br /> III /7/s Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION an includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ,2 ■ 7.4.r s 4;1414 1ivF 6 r,,,4,:lit 6 Kir..c';.ra 1 vc_ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 17 7/ 12 5 /71w/ 57 etbacks <br /> (City,State,Zip) (City,State,Zip) <br /> PHONE PHON r.w� ,.( (/�y S TSj� I�e Plan approval from <br /> > 1 �a applicable township. <br /> �i,i� �SE - �`77� PP P <br /> E-MAIL ADDRESS -MAIL DDRESS <br /> i' ke (t;441 ❑ F oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑ NUMBER 0 7c -/i3 -- egg,5- /9-- / I /ha f .ntage drawn to scale. <br /> TOWNSHIP: SECTION: , 1 1 rlveway permits <br /> 1 /4: S �4/4: 5 c. al <br /> o 7 (state,county,town) <br /> ADDRESS: bSL � , <br /> tI - wT anitary p s <br /> •CSM: LOT SUBDIVISION BLOCK/LOT <br /> //cSS Z public,private) <br /> I <br /> PROPOSED PROJECT INFORMATION x'.a ;' 'FF REVIEW <br /> PROJECT DESCRIPTION; '/ <br /> /) - ILrs,I A-t t/ f picliconing District <br /> L7 This project is a new building or structure. <br /> lb Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ R r.I Address <br /> 0 SEWER ISEPTIC SZ L existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 7 / ., ,,I etlandiRix4Plaini <br /> S <br /> AREA TO NEAREST SQUARE FOOT: 'Telclnd'(attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) r 4, <br /> BASEMEN 1 S T FLOOR. (� ®stcC )_ rmrt <br /> C ���� f� 0 �) ,�, TOTAL SQUARE FOOTAGE: ,, S°••- ,disturbance, <br /> tor 2N LOOR: {{{ ��� 3RD LOOK: ���„/// g/access) <br /> 4 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ `f CL G C <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ..., Cl Yes iii No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes IiiNo ❑Don'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 C No <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) DYes ei2612 12 Don't know <br /> 7. Is this to correct a violation? ❑Yes 'No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ ♦ -► <br /> 545-112(4/08) <br />