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ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CU ER TO PROVIDE <br /> WW1 NAME <br /> (4i K.e_ 4- L'i - a e-✓1 ping Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> PO Bc5X S L2,3 30vt Pfbar'i 53590 Variance(# to 1.76 <br /> HOME PHONE CELL PHONE E LADDRESS <br /> Al 4 ( ô is-•333--- •I •iQi` -• . 1-i A€ram/.ct t 16e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ■ytl, (Nolk I ❑Site Pla incl ng location <br /> AGENT ADDRESS CONTRACTOR ADDRESS A)'1 3 J,( popio.r 4iF& of well/ c <br /> (City,State,Zip) (City,State,Zip) - — =❑Sett <br /> Co.�M.bn'cla e1 (.J 1 5 35 a.3 , <br /> PHONE PHONE ❑Site PI rr - •• /4.#. :I from <br /> (.Q C$ -.1445 _ -t iO O appli r. • .. • I ip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> , DO`k' SS CD car. ¢- ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:r accessdane.co.dane.wi.usr') El Elevation of p <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NPUC�ELR X11,(!/�7/,,111_ yd� 1,'3 Z .(.,Q 9 g frontage drawn to scale. <br /> TOWNSHIP: SECTION: Drive ptt5 <br /> � `el i 5 /.: _�V hA: N a rr town) <br /> ADDRESS: - /1 <br /> illo -5 <br /> CSM OT SUBDMSION , BLOCWLOT ❑San r rnit5 (� <br /> (publ rivate) vV 1 <br /> 134p � <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: _`G� <br /> A) VI C)tM.e-- ❑ Zoning District <br /> . Is project is a new building or structure. ❑ Permitted Use? <br /> is project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE PERMIT NUMBER ❑ Rural Address <br /> nEWER PEPTIC 13 --�1' Ka' aCa 4_ (new/existing) <br /> HEIGHT IN FEET: a o ft NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO REST SQUARE FOOT: <br /> (Outside dimensions including unfinished including,attached garages and above grade decks or porches) <br /> BASEMEN 1ST FLOOR: r ❑ ErosionControl permit <br /> Ci4 I� J 1 i, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FL 3RD FLOOR: 1[J (,(- �j <br /> filling/access) <br /> fl6r"�� � - \ `� ❑ Rev'- L• -. r � -y <br /> ESTIMATED C NO STTRRUCTION COST: and ava - ,I. •• 1••:. id <br /> (Please round to nearest dollar) -► S 3�t-5, C�o <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes no EPon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies o DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? IQ es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ill es o <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) es Flo [on't know <br /> 7. Is this to correct a violation? es o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i -+ -► <br />