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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER N "F <br /> I!likaiik4 curd eSS �` tatus; CUP; <br /> OWNER ADDRESS (NJmber,Street,City,State,Zip) �/ Deed Restriction; CSM <br /> I2gS v �t�, I-u L , 92, VevO 5 59 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> (PO?'?32".4g3g an drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> CIec - ,1chit.q a) e Plan including location <br /> NT ADDRESS CONT CTOR DRESS of well/septic <br /> 1 0 ao-e( %t <br /> (City,State,Zip) (City, te,Zip) tbacks <br /> v e l/ta , W I s 35d13 <br /> PHONE <br /> (PHON , Plan approval fro <br /> 605 ?4(S- - �J'7O o applicable township. 1 <br /> E-MAILADDRESS E-MAILADDRESS �� <br /> r plans to scale Q <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Ele Ion of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE:-7 P P y <br /> ❑UMBER D5o7- III-'t5/I- 6 A - 1 (� x ) 33, /d ntage drawn to scale. <br /> TOWNSHIP: 'A 1 SECTTIOF�N:: //-5 - 7A <br /> V ��[•V`U`�1�- �+ '/4: ,V E '/4'/<: ❑Drive - -rmits <br /> ADDRESS: (Stat= • nty,town) <br /> I2�5 ¶ i-CLL. �lt �[uJ� d 2- V��tGL t ) I �j'�5�3 �Sani . its <br /> CSM: LOT SUBDIVISION BLOCK/LOT (p ivate) <br /> PROPOSED PROJECT INFORMATION TAF REVIEW <br /> PROJECT D it RIPT N: f 01- .e4c( i d G1 CL6,∎.ci ci e-. 1 Q, Q . oni District <br /> � <br /> XThis project is a new building or structure. rmitted Use? <br /> This project is an addition/alteration to an existing building or structure.A SANITARY SERVICE: PERMIT NU BE : Li Rural A• <br /> DEVVER i'EPTIC (new/ ` . <br /> HEIGHT IN FEET: u NUMBER OF STO ES/(Not including basement) ❑ <br /> . 15 14 11 •.r. ••• �� <br /> AREA TO NEA T SQUARE FOOT: <br /> tiaiiiii-"Rmr"-- - -nt) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) t7 rOSIOnCOntrol permit <br /> BASEMENT: 1ST FLOOR: <br /> L�o0 , TOTAL SQUARE FOOTAGE: + (slopes,disturbance, .--- <br /> V filli /access) U <br /> 2ND FLOOR: 3RD FLOOR: q00 y <br /> eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ p and available opti ns. <br /> (Please round to nearest dollar) h 13,00 <br /> AiQ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Wes o Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Res o Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Wes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? t'es alo <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) It'es -�c Vo Don't know <br /> 7. Is this to correct a violation? D'es o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/05) <br /> (Continue on Back) -+ ■ --• <br />