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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 /> 1756 7iVini /4 iCI oning Status;CUP; <br /> OWNER ADDRESS(Number,Stre City,State,Zip) �"� <br /> _±....• -`_-��` At ,Ave �,�i_, 7o V i� � S q Deed Restriction; CSM <br /> HOME PHONE r CELL PHONE E-MAIL ADDRESS /7r4 u�^ �J�% Variance(# ) <br /> r a' -5 Y45 S' Ian drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> jPr5ell ,17', CCI1 7 tt r 2rJ rU,Sit Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/se tic <br /> l0 Of3<O �e_.2.4 / <br /> (City,State,Zip) L617, 5- (City,State, ip) acks <br /> 3. 5 <br /> PHONE PHONE ❑Site Pla royal from <br /> a e township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS • <br /> F r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: EI n of property <br /> ❑PARCEL Q 908-07-7/35f46 A—/E 3'7�j ntage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> P/91)- - 1/4: '/4'/4: ❑Drive ay •-rmits <br /> ADDRESS: (state •unty,town) <br /> !a Sanita •- its <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> Pubs • <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: t <br /> D , !+ lc 29/ /)G �( v Z Ing District <br /> . This project is a new building or structure. <br /> P 1 9 P rmitted 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/ <br /> HEIGHT IN FEET:, U rte NUMBER OF STORIES: (Not including basement) <br /> / Q ❑ illltTd d/ o lain/CA " <br /> Shore (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: OSIOnCon ro)permit 0 <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: ��� filling/access) <br /> 2z), view Location Survey <br /> ESTIMATED CONSTRUCTION COST: vai e options. <br /> (Please round to nearest dollar) --► -► ♦ ♦ ♦ ♦ $ ' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes o ❑Don't(-7 <br /> w <br /> 2. Is there a wetland or floodplain on or near the property? Ekes o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? INYes II o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes _UNo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if hone) <br /> 6. Is a location survey required? (see reverse) Ekes a1, o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes /'∎ o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —1 ■ —► <br /> 545-112(4/08) <br />