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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> / . -- 6 , <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 'Tt-le roof @2. EUMPONti LLC Q Zoning Status; CUP; C i ;r <br /> ovyNER ADDRESS (Number Street,City,State,Zip) <br /> j_]1C�./yVt�Qj I 1�� Deed Restriction CSM <br /> 11 W/d tJ ka J V r�,fiance(#r1�1o`�43 ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS N¢-tef1 flt,A n1 <br /> 60g-Sib-i19s9 t kknM* e 444:4.64^'k ©Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> r �,,/ 511-e f .665, 5)41NS --54Me 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 311 11415- , 541 14,,e, ..5154-(Ci ,State,Zip) (City,State,Zip) Setbacks <br /> N!) 01A, Loci w-f. 51,035 6eam.e <br /> PHONE PHONE Site Plan approval from <br /> gZ0 . 579- 5 41 q 5Am,e applicable township. <br /> E-MAIL ADDRESS / E-MAILADDRESS <br /> till ! / N e L I ✓e , C OM' ` 5,0 fte floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING ACREAGE: [ Elevation of property <br /> ❑NUMBER PA /0710..0111 *22'2 19(: <br /> ♦' <br /> , t 6 3 outage drawn to scale. <br /> TOWNSHIP: SECTION: J <br /> Tao OF- V(00m)P3 &R cV e _ ih: N j"� '/a : S v" Driveway permi <br /> ADDRESS: A� (state,county,M <br /> TU0g !"1 i I W .5 f pS... -ry permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> ISO CS(' 2)3 L publif, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: g_.1`e'(It&ek i 5�,Al PO l e Si IU /(z /)ew II�l�u N5 Zoning District C — <br /> . !This project is a new building or structure. Permitte Use? <br /> This project is an addition/alteration to an existing building or structure. 19 10 vN/ A I <br /> SANITARY SERVICE: PERMIT NUMBER: (*Rural C q h <br /> I,.e x I <br /> EWER [EPTIC (new/" 9 <br /> HEIGHT IN FEET: v NUMBER OF STORIES: (Not including basement) <br /> j i)v4_ , -=.=_• loodplain/ /� <br /> l Shoreta o. (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1 ST FLOOR: 0 ErosionControl permit <br /> ( j TOTAL SQUARE FOOTAGE: j (slopes,disturbance, erOA <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) � e 4 <br /> i 2- / I> Review Location Survey r <br /> ESTIMATED CONSTRUCTION COST: j 7 and available options. <br /> 6,1 (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ 7 J �, U 0 <br /> 7 i 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes i*o Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? rgles ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Elves ❑No X <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# 10.7q5 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ['Yes GIN() ❑Don't know <br /> 7. Is this to correct a violation? / ❑Yes o <br /> 3 P /0 h l 5—k``p A 2 ©4/3 Y" k S N S/ APPLICATION MUST BE SIGNED <br /> 545-112(4/08) ftrd /J 2 / (Continue on Back) ♦ ♦ -► / <br /> .- 3���k V1/ /( 30 i, p � /0 0 0/20 I <br /> We /i S I2 <br />