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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 /> CPA-16 ci kp Rit�Sc; i CI Zoning Stat , UP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 363-52- N.l 9 ST- 5Z4. Deed R riction;CSM <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 2o6-S7sS-A23•z <br /> Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION a d includes dimensions <br /> AGENT NAME , CONTRACTOR NAME <br /> AOCloC- TErt ft-14 if Ai 4-gcig3 /1/©A.evcl,Q Cosro ■ ii its Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS 7 well/septic t <br /> Slirm t AS 8v/ -2 2c3SS"-noc. ..11.o AiIiC 0l .n <br /> (City,State,Zip) (City,State,Zip) Id S-tbacks <br /> PHONE I07, Ni w/, S-3)/I t <br /> PHONE i Site Plan approval from <br /> 27(f 6og- 2� -0Wo. /applicable township. <br /> 4 <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> 5d F or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usi) <br /> PARENT PARCEL NU R: r/CURRENTZO G: ACREA <br /> El vation of property <br /> Li PARCEL ©� —�IIJIQ_l I . YQZ I g <br /> NUMBER onta a drawn to scale. <br /> TOWNSHIP: <br /> M � SECTION: ,,I �-- <br /> I 1 i !do r\ 3 1/a:S 1/a1/4: / i ►L DDrivewa its <br /> ADDRESS: (s t ounty,town) <br /> CSM: LOT. SUBDIVISION BLOC OT Sanitary permits <br /> 'Zrtir t� 6='4 • A i 0.--/ , (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> /WE r.t..) Si,'6 & it/7?,/4 7 ietierfrn X, •l / 0 r C._ a oning District <br /> This 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: ) ®•- 'ddreSS <br /> ❑SEWER SEPTIC 5 0 / Q newt 'sting) -'" ,f <br /> HEIGHT IN FEET: ' 5 NUMBER STORIES: (Not including`basement) / <br /> d l/`Jl D wetiancnd(a alaittachnt <br /> AREA TO NEAREST SQUARE FOOT: ment) ` <br /> Shoreta�rd (a ` <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) r (2--, <br /> BASEMENT: 1ST FLOOR: Erosion CQntRt ' rmlt <br /> 0 7 )'? .7(S i j TOTAL SQUARE FOOTAGE: l (slopes,disW , x <br /> 2ND FLOOR: 3RD FLOOR: ftlling/acss) <br /> /56 w Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ �� �� and available options. <br /> (Please round to nearest dollar) / oc2o <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ' ❑Yes )$.No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Et No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes 21No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Li Yes ONo <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 I No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) <br />