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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAM CUSTOMER TO PROVIDE <br /> -D�V lk G V <br /> v . Qs,` <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ❑ Zoning Stat ,CUP; <br /> 385o swoloo 12k.` 1 e���0 �I �J, 3CJ ci3 Deed riction;CSM <br /> HOME PHONE CELL PHONE L-MAIILADD�ADDRESS l Tar' ce(# ) <br /> c9CA-Say-*. g5 a . <br /> ask., ' • %I ' to Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> &eners 0�es6nsLiankscce, q„tInc• E 5 fie, ite Plan including location <br /> ENT ADDRESS l CONTRACTOR ADDRESS of well/septic <br /> Y.O. Zox 621_oBoC <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> MA1(1 , , wr 5 3 5G,'L <br /> PHONE PHONE ❑ Site Pla pproval from <br /> 08.8 a - 0009 appli le to nship. <br /> E-MAILADDRESS E-MAILADRESS <br /> tn�0er_or'V�cesfarl2rhes isoocmaSij,.on. CoVt,-, ❑ loor ns to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us!) <br /> PARENT PARC L NUMBER: CURREM ZONING: ACREAGE: frontage of property <br /> ❑ NUMBER �8�O` -1-`i 4-�a5 -3 A I II frontage awn to scale. <br /> TOWNSHIP: t' oL <br /> SECTION <br /> AAA\ in i ci -1/4: SE 1414: N W ❑ Drive ay permits <br /> ADDRESS: (st ,county,town) <br /> 3S5o sw-oloocic+` k i•, VeAm,c.___ kos' ❑ sanit <br /> CSM: LOT SUBDIVIS ON BLOCK/LOT permits <br /> AS alt.(' jc,nes (pu c, private) <br /> PROPOSED PROJECT INFORMATION <br /> STAFF REVIEW <br /> PROJECT DESCRIPTION �Okt-n <br /> .0 7 A 0{I 10 Zoning District <br /> ❑This project is a new building or structure. <br /> try Permitted Use? <br /> This project is an addition/alteration to an existin building or structure. <br /> SANITARY SERVICE: PERMIT N MBER: ❑ Rural ` - <br /> ❑SEWER ,04 SEPTIC tie e i l , <br /> HEIGHT IN FEET NUMBER F STORIE : (Not including basement) ' <br /> �' , ❑ Wetlan. ` ioodp -'n/ <br /> AREA TO NEAREST SQUARE FOOT: Shor nd ( `"chment) <br /> (Outside dimensions including unfinished area,attac . d garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ''11 ❑ 'Sign v. trET it <br /> 4, TOTAL SQUARE FOOTAGE: 4, •4".•dtStu 'ce, <br /> 2ND FLOOR: 3RD FLOOR: illin r'access) <br /> ESTIMATED CONSTRUCTION COST: Review Location Survey <br /> (Please round to nearest dollar) "'r -+ "'� '♦ ♦ ♦ $ \I O� o o and available options. <br /> M <br /> 1. The property is within 300 feet of a stream or 1000 eet from a pond or lake? ❑Yes Q No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the prope y? ❑Yes Flo ❑Don't know <br /> 3. Have you talked with the township about your proje t and are they in agreement'? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this prop rty in the past 5 years? 1�Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/Varian (petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes 11/No <br /> ❑Don't know <br /> 7. Is this to correct a violation? Li Yes tla No <br /> ,.....i& <br /> p _ APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -i. -► -♦ <br />