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4 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> M1 s 14A EN 'c'1 ❑Zoning Status;CUP; <br /> go/ADDRESS (Number,Street,CAI( ate,Zi ) Deed Restriction; CSM <br /> go/ Clilit O R XI J. ( uics,01.'z. iwz,� Variance(# ) <br /> HOME PHONE r,-�� CELL PHONE E-MAIL ADDRESS <br /> A 1— 33V- D ,�`Z1 a Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NA E <br /> W15�(�ibA 1�UP6�� 4- e_ IM1CAt � � ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> / DCIc21 iorYwk G. - 5-411 <br /> (City,star OD v (City,star 5-1/4,3c`7 ❑Setbacks <br /> F-.3 LUe PHONE PHO (/ ❑Site Plan approval from <br /> 60g - (��l3 " 3 zq7 ea -a a l 3 - 3�47 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDR S <br /> rn la e (Dist f//6i ry P. v4 i-, ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZO ING: ACREAGE: <br /> PARCEL j�2Z3 ,q/c/s- ..1 ?14 ' _, ,4 frontage drawn to scale. <br /> NUMBER <br /> TOWNSOIP SECTION: <br /> r-v-RR(L 22 1/4: 5 1/1/4: 6W ❑Driveway permits <br /> ADDRESS: COO r � � (state,county,town) <br /> l/l,/,li�C/o W✓ ❑Sanitary permits <br /> csM: LIST SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> to Es-t) beck j t-4 K )C 2- -1--q u ❑ Zoning District <br /> `= •is •project•is a new building or structure. U Permitted Use? <br /> ■ This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER r)EPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 7_< ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> ❑ ErosionControl permit <br /> TOTAL SQUARE FOOTAGE: ,`, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 31-7 I ie <br /> ESTIMATED CONSTRUCTION COST: ❑ Review Location Survey <br /> (Please round to nearest dollar) '∎ "-� ♦ ♦ '0. • $ ' 2 000 and available options. <br /> i <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 8Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Elves ONo `!Don't know <br /> FXSoliei <br /> 3. Have you talked with the township about your project and are they in agreement? dEfres ENO 4.T lOW UJ <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? VilYes Olo tAk4de 10-11-14, <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) Elves clo ['Don't know <br /> 7. Is this to correct a violation? Elves cialo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4 -4 <br /> 545-112(4/08) <br />