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P 0 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUS OMER TO PROVIDE <br /> OWNER NAME <br /> 6V 1 h * ��`Q 01.- ` e Y' Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) nn J Deed Restriction;CSM <br /> N 91220 \,a i(6 odic ? C 9 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 620V 42.4- o3%9 (,o8-u44- '7 35 OKO 8220 C\natrAcv * 1VG4 'e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION ' a d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Sok ln kuhle ( rdhlesir cn. Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> N1\E 1�.0 . $u y l7 / u,cekv rck St- M/ <br /> Setbacks State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE Gr a 35, i.te Plan approval from <br /> ( og-%Si 7-61`4 a plicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of ro ert <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P Y <br /> 0 PARCEL K 3 1 3 0 SO5 t frontage drawn to scale. <br /> NUMBER bb �07Y06-AS3-9400- . <br /> TOWNSHIP: SECTION: )9 <br /> Al• '/a: 1/a1/a: Driveway permits <br /> °� ` ° k F°'r �` "''" — (st. e,county,town) <br /> ADDRESS: L . -170 i 0___(9-61 e- -ry permits <br /> CSM: LOT SUB' ISION BLOCK/LOT <br /> j 21 L L1 � • Ic,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> (o ing District <br /> This project is a new building or structure. Permitted Use? <br /> U This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 0 Rural Address <br /> 0 SEWER S-1 %.2-4.05- ( existing) <br /> IN FEET: vi ( gSEPTIC <br /> NUMBER OF STORIES:(Not including basement) <br /> Ii ' etiand/Fioodpiain/ <br /> Shoreland (attachment) <br /> A- A TO NEAREST SQUARE FOOT: <br /> (Outside dimensions•- .-'n• . inished area,attached •. -• bove grade decks or porches) <br /> BASEMENT: 1ST FLOOR: lAroSlvnonticil Permit 1 4\42 <br /> Q°'-78 �f ��� ao 78 s347 TOTAL SQUARE FOOTAGE: (slopes,disti 1 T , <br /> 2ND FLOOR: �[ 3RD FLOOR: �j / �ji ) <br /> 4 I-C-(e. \, v 1> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦♦ ♦ and available options. <br /> (Please round to nearest dollar) aat�I 0 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 0 Yes ciNo 0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 0 Yesio 0 Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? i.Yes O,No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 0 Yes ,No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blan if none) <br /> 6. Is a location survey required? (see reverse) 0 Yes Aallo U Don't know <br /> 7. Is this to correct a violation? ❑Yes *Jo <br /> Jo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ -► -* <br />