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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN R NAME <br /> -, '• .1.40.0144..r7 <br /> R Wing Status; CUP; <br /> OWNER ADDRESS (Number,Stre-,City,state Zip) eed Restriction; CSM <br /> ll ZZ D' '` V <br /> •1{;►�•HONE LL- ONE ivtooar 1i W( Variance(# ) <br /> A i -114 'r. :,;,0 -A f, ; / ...4 .4 d 'J . I ' Ed-Site-Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRALTO ii,rf• W IKf a" <br /> Ite Plan including location <br /> GENT ADDRESS CONTRALTO ADDRESS of well/septic <br /> TO. K 0ZZO Q <br /> (City,State,Zip) (City State,Zip) ,r' G EIS‘—packs <br /> PHONE P� ( 4 ( '/� a Plan approval from <br /> 6*'6 tiw applicable township. <br /> E-MAIL ADDRESS E-MAIL DRESS t <br /> Fl plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: /cI/ ACREAGE: Elev ' of property <br /> ❑NUMBER 04410(160-311-611115-0 outage drawn to scale. <br /> -- �(-l - 1��3i i�� 3 �7Z <br /> TOWN HI� SEC ON: /4: I4� 1/41/44W74 ❑ <br /> � , Drive ermits <br /> ADDRES ,co ty,town) <br /> ii "J�I ygUY • • % ' I- 1 357Z ❑ ta s C I SUBDIVISION Bo l <br /> (pub pri te) / b <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCR 41t/Mee I�1� ^ Zoning District <br /> g�TThiis project is a new building orr structure. ( rmitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> new/ <br /> HEIGHT IN FEET: PEPTIC NUMBE OF STORIE�(Not inGuding basement) ( <br /> (jt# I&\ rA�, / � c ❑ Wetlan• oo,.lain/ <br /> �`� `�f� Sh• - - • •ttachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ Eros ••••ntrol permit <br /> ItOW�f 4, TOTAL SQUARE FOOTAGE: , (S ••es, •_sturbance, <br /> 1 OW (l <br /> 2ND FLOOR: 3RD FLOOR: � <br /> I 1 080 4F 9 -eview Lo - ry- <br /> (Please round to nearest dollar) $ A 44 G,� ) an. = :liable •• •nS. <br /> ♦ ♦ ♦ ♦ ♦ "C �!W <br /> 4 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Nvo ['Don't no <br /> 2. Is there a wetland or floodplain on or near the property? [Yes Ilo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Wes alo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes cgiNo <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) Ekes e o ❑Don't know <br /> 7. Is this to correct a violation? [Yes IQ o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -♦ -► <br /> 545.112(4/08) <br />