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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 /> T 1M S:aF 14-00 5 Wing Status; CUP; <br /> IDiet OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 3t4to WAUCH�E TA TP-A%L- . Neva1710N W1 S3-I►t <br /> Variance(# ) <br /> f HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ((og) z1-- -113b Sit an drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> t-►oar PENO8t-E. 6u►L.P - HAT mNot3)_.t: gut►-c. F-5 ❑ Site Pl.- including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of -I se.tic <br /> -1`IZ3 AtRPtoPT RD `l`-1Z3 AItZ1t,R-T 1Z.D <br /> City.State,Zip) (City,State,Zip) ■1 S tbac <br /> M1pP1-rToN Wt �3�(nZ r•Ainp-ETON Y•-►t 53Sb'Z <br /> PHONE PHONE Sit Ian approval from <br /> ((oog) 83 t - -VA Z z_ ((,o8) £3► - 414 Z Z plic township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 5'40Fz-1140ost—iO3 5 u1L Pr-RS• wM F or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/laccessdane.co.dane.wl.us/) vation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE P t y <br /> ❑PARCEL O-051-415(o-4--) R - z 1 131 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> TOWN O1- DuNN 1/4: 1///4. ❑ Drive permits <br /> DDRESS' (sta , c nty, town) <br /> 3t4to WAUc. 4 ETA `Rai L- , MA 01So1V t/V 1 A5 3-t t 1 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanita p- mits <br /> (publiivate) <br /> AIL <br /> PROPOSED PROJECT INFORMATION AFF - EVIEW <br /> PROJECT DESCRIPTION: <br /> NF W DE -D STVR,A k 6,Arz-6.c,E oning District <br /> . This project is a new building or structure. P miffed Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE PERMIT NUMB ❑ Rural Add_ s <br /> EWER �EPTIC (ne sting). <br /> HEIGHT IN FEET NUMBER OF ST IE : (N including basement) <br /> t . S 1 <br /> - .•./Floodplain/ <br /> ' .ttachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> I• • • ontr. •- <br /> BASEMENT: 1ST FLOOR: <br /> 561 1 8 4, TOTAL SQUARE FOOTAGE: 4, ( opes, disturb.• <br /> fillin• . - s <br /> 2ND FLOOR: 3RD FLOOR: <br /> 5x31 1`d <br /> Li ' -view Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ l 3 1 ooO and available options. <br /> (Please round to nearest dollar) \ <br /> 3,r.ss <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es ❑No ❑Don t know <br /> 2. Is there a wetland or floodplain on or near the property? es ENo ❑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 ❑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) ❑Yes ❑No ❑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 />