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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 /> 6AR Y "4-' .- Br4li �'�L8 oning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) , ,/ Deed Restriction;CSM <br /> 1l'9Z Se416/e G iQ0.1O 13/.44' bei.e.iit 7 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 767- Vol c76-69? 3 • nom, ' Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME .144 . 77 <br /> JG'iJ' i 0y.4iy c AT 7— • 'e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS / of well/septic <br /> 704 risfAutak Aw. csil /F �� <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE T /� 1< 7`czf • a oval from <br /> 60/'-5It-COO, applica wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> dd.1End'frl ficii/S !1�l oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑�levafiOn of property <br /> PARENT PARCEL NUMBER: CURRENTZ N G: ACREAGE: <br /> ❑PARCEL 0807-321-172C-0 A- I <br /> NU , 3 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> - %4:-z _ - '/<'/4: Iveway permits <br /> ADDRESS:�� �--- (state,county own - <br /> 912 y S AF<BEI . Q D 8/-u-, 04 6-3 is <br /> CSM: LOT SUBDIVISION BLOCK/LOT nita ry •ermltS <br /> 1933L ` (public,iiifibo v . <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW .y / <br /> PROJECT DESCRIPTION: <br /> f E,,c! e `1-10/4td ping District c�C "' <br /> . NThis project is a new building or structure. permitted Use') <br /> This project is art addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PER 11.4.1T NUMBER:/` \ q L Rural Address <br /> EWER PEPTIC )2 -- ()I E'— O v c- I I (new/e S�Ih <br /> HEIGHT IN FEET VVV"`"' NUMBER OF STORIES: (Not including basement) ��✓"J <br /> 2.7 / 1, H C tl�/etlan dplain/ <br /> t-' Shore d ttachment) <br /> AREA TO NEAREST SQUARE FOOT <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) EfoS. ntrol permit <br /> BASEMENT: 1ST FLOOR: r, . <br /> 4, TOTAL SQUARE FOOTAGE: + (Slop , i rbance, <br /> ZIG� :31�/ fiil'in /access) <br /> 2ND FLOOR: 3RD FLOOR: ,,� <br /> 5Z(" f5Y--view Location Surve <br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ♦ ♦ ♦ ♦ ua� - d available o• '• s. <br /> (Please round to nearest dollar) $ 7 d ,MMO• <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes .®No ❑Don't kn 6_,S <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes glo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? XIYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes EINo <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 alo ['Don't know <br /> 7. Is this to correct a violation? [Yes MN <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />