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ZONING PERMIT APPLICATION ww .countyofdane.com SUPPLEMENT to Web-App # <br /> w <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME n <br /> S f-e✓ en Par Ic I.n 50,2 <br /> 1712.6-iing Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 68y'Z vZ Br u,n Lr� Sr4r� Pia i y,i' e w? s�.s�� Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 08-33s-asyj sP•It <br /> - 130 Gr.4 I i•(-"904~ ' e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> S. Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) <br /> acks <br /> PHONE PHONE ❑Site P -n .•.._.val from <br /> appli -. - township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> oor plans o scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) anon Of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p P y <br /> El PARCEL <br /> ER 09//—/y3—9e6/-8 ,4 -/ / v?o? rontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Brsj S j1-p/ /`l' 1/: c$t4' '/41/4: J E ❑Drive ermits <br /> ADDRESS: (state,co nty,town) <br /> \/ <br /> __4 67v2 Br;Q ✓' Ln c$ua P'rai rt`t_ L4)_" 53S-0 <br /> El Sani ; rmits � <br /> CSM: D LOT SUBDIVISION BLOCK/LOT (publi .rivate) `� <br /> PROPOSED PROJECT INFORMATION 'C� <br /> STAFF EVIEW <br /> PROJECT DESCRIPTION: � ,.� � <br /> /geed tare 4641 i /f 11 ii/ 'j�yC ..S�eaf; LiZoning District <br /> ZThis project is a new building or structure./ P fitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWEREPTIC (ne <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) \� <br /> Vaptll r o l . 4- )1.-c / ❑ ' - • -• Floodplain/0 <br /> AREA TO NEAREST SQUARE FOOT: <br /> ore an• -ttachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST OOR: ❑ ErOS10r1C01 • •ertnit <br /> TOTAL SQUARE FOOTAGE: ,, (slope distu •a ' <br /> 2ND FLOOR: 3RD FL R: <br /> filling/a0 <br /> y0 ' <br /> eview Location Survey <br /> ESTIMATED lease round CONSTRUCTION)COST: -► ♦ -► ♦ ♦ ♦ $ �� and avail e options. <br /> Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes 'lo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 'lo g(Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? E]Yes ao <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ao <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 \lo ['Don't know <br /> 7. Is this to correct a violation? Elves [ ,lo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) ■ -♦ —. <br />