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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C -TOMER TO PROVIDE <br /> OWNER NAME <br /> pa.` __o X-V-..So. �e 5 2 ning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction; CSM <br /> '7©gg`�' /�,�-‘v\ S+• 5 � � �3''&`� Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 8\S---9-13:3c>7 8 ..VAic'L.-%N'QmV`w. VIAQ`X'(4‘'" ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME C�O/NTRACTOR NAME <br /> / e-LSox Redd/ 4 Sei ie.cs Li-c• Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS' of well/septic <br /> 6-lee 7y/>v-//-He <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> 443,, GU.--. S3.5- <br /> PHONE PHONE ❑ -ite Plan royal from <br /> C-1,6' a?-c-- y//3 .•pli a township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> /1e.thovt 6 c.),LA _ �wlao/.«_ LV/ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) u levation of property <br /> PARENT PARC L NUMBER: CUR NTZO NG: ( 1 ACREAGE: frontage drawn to scale. <br /> ❑PARCEL a - 74, ;6 - -•C \l 3• <br /> NUMBER <br /> TOWNSHIP: /f / • SE TION: 1 , 1 Driveway permits <br /> j/rL(/ ��� �4' 1� �4�4' (state,county,town) <br /> ADDRESS: // // /f <br /> �? ' f-654'4 4 A -r/` / (l)z Sanitary permits <br /> CSM: ////%% Laaff / SUBDIVISION BLOCK/LOT public,private) <br /> PROPOSED PROJECT INFORMATION p STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> *40`f']/7 Y►- 117 Zoning District <br /> . ®This project is a new building or structure. d ermitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIMBER: ' • a `ddress 3* <br /> EWER ytEPTIC ~�©I ©Q (new/- isting)17 HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) [I Wet)and/F plain/ <br /> Shore) (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) EroSiOr1G0 QI permit <br /> BASEMENT:Z y„‘ 1ST FLOOR:( ?C e-- /0 >CJ <br /> ` TOTAL SQUARE FOOTAGE: j lopes StUYt)anCe, <br /> thin cress) <br /> 2ND FLOOR: 3RD FLOOR: �{} 7 <br /> v Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ --► $ / rs?,,3;�00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 'lo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ElYes to <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes EiNlo <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) Dies IN! o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ -► -+ <br /> 545-112(4/08) NdCS , <br />