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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> ,"-*** O W f.1 O /u 11' i0e7 at , Zoning Status;CUP; 4 i 7/ <br /> OWNER ADDRESS (Number,Street.City,State,Zip) Deed Restriction;CSM <br /> -,11 ')11 Ofd -s7-11-6t (zd r..�rc�o,�Lyt11/al S'S21 ©9,� ) <br /> HOME PHONE � tLL PHONE E-MAIL ADDRESS <br /> ,rob '/SS' 3925 :9 3'8) C)&f 0 )77 - a o/• "0 "1 A Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ✓Y) 12f f e . , s/�wi€E/E$S kSite P - •kchiding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS 0 = Septic 4/04_ <br /> (Cay,State,Zip) (City,State Zip) X Setbacks <br /> YI?4-Pi Sv.v S37/"� <br /> PHONE PHONE , K:ite Plan approval fr�Drn 9 8 9 pplicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> !',e e c i e' _CA c w C.oo rAl Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:Uaccessdane.co.dane.wi.us/) �� Elevation of property b <br /> PARENT PARCEL NUMBER: CURRENTZO ACREAGE: <br /> a PARCEL r -� .4-P i t7 aoo G';' frontage drawn to scale./ c,I I <br /> NUMBER oS2�Os)t� -/7/"9,1a�-o � � � � j 1 <br /> TOWNSHIP, SE ION: ( Opp/ <br /> l U �''AO 0/ Al £ Yi: _G IRA: Drivew its i'A <br /> ADDRESS: ` (stet uh ,town) <br /> ()2. 3 2 C1-y R w '/ 4 XSanitary •- .•. s �/� <br /> CSM: LOT I SUBDIVISION BLOCK/LOT (publi• • �f <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: - <br /> ern�oied CO►M►�+Le/,co Jr.,, Tower SD c tr ecin(oanc� ZaningD' 'd <br /> Caw /� <br /> . alibis project is a new building or structure. ( T>'iE4Ct'i .ise?/V0� <br /> 0 This project is an addition/alteration to an existing building or s /ure. J�SANrrARY SERVICE: 4 PERMIT NUMBER: t'I21 Rur�:- - s❑SEWER J SEPTIC k n- existing �IN FEET- NUMBER OF STORIES: (Not ding basement) y�T/ <br /> � Wetland/Floodplain/ <br /> -1w/ i bid /D / 4'S <br /> 9 ,horeland (attachment) , , <br /> AREA TO NEAREST SQUARE FOOT: off <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 44) <br /> BASEMENT: 1ST FLOOR. <br /> ErosionControfpermit ( . <br /> 3 I© +TOTAL SQUARE FOOTAGE: + slopes,disturb ante,l k/ /f <br /> 2ND FLOOR: 3RD FLOOR: filling/access) - ((!!! <br /> 3!0 Revtew Location`Survey <br /> ESTIMATED CONSTRUCTION COST: ar davailable options, <br /> -► -► - . - , - . -� / <br /> (Please round to nearest dollar) ���qV /tT <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes !$No 0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? !Li Yes L No J Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? AYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes a 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) S /1 fine I,. d ❑Yes Li No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ,I No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► ♦ -► <br /> 545-112 Wm) <br />