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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web App#'. <br /> ;PROPERTY OWNER:INFORMATION,;, '` i .. CUSTOMER TO PROVIDE• <br /> OWNER IV ME <br /> Q_ �ckn,Q_ v\ e_r W I .�L ['Zoning tatus; CUP; <br /> OWNER ADDRESS (Number Street,City,State Zip) g <br /> ` Deed Restriction; CSM <br /> 2 \ \® LA .cQ\c A. Vim_ 1 �l.J 1 G3-(�'i Variance(# 347S- ) <br /> HOME PHONE CELL PHONE E-M ILA DRESS t <br /> (a DS 2\1 - '( Cod o`-2-‘23-16q t �S�e. 2 J a o 1 , C e v^---- 0 Site Plan drawn to scale <br /> AGENT INFORMATION, . ._;'` - ; 'CO W.i.Itik00 KT INFORMATION -fl ,`, and includes dimensions <br /> 'AGE T NAME CO TRACTOR NAME 00� "`S S�eec1 e CONTRACTOR 1 <br /> \vC , 0 Site Plan including location <br /> AGENT ADDRESS CANTRACT ADDRESS of well/septic <br /> Z`\10 Cam. ‘6o>c 2 <br /> (City,State Zip) ( ity State,Zip) ❑Setbacks <br /> 1` c-- ∎.Sow (,) \ �''c0q VD\&C4 .61/40\ w\ S1S \ - <br /> PHONE PHONE ❑Site Plan approval from <br /> (oQA?). - Z\')-Q fo 4 ' Luca I(- -1 _Z, Z1 applicable township. <br /> E-MIL ADDRESS E-MAILADDRESS <br /> • <br /> c 4-ees e a O( , (o'1, --, 1\_ E, mz` 51kNk0S <br /> ,c,e).,c---- ❑Floor plans to scale <br /> '_PROPERTY/LOCATION INFORMATION (http://acces5dalie..co.d0R4Svvi:uslyii:.AQ; ;Q:ci,, r—i Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL // frontage drawn to scale. <br /> NUMBER ��Ob"'��Z— SZa-c'� � �IEjC O� ' <br /> TO SHIP: SE ON: <br /> 0.0 SON(-'1}�h 3 Y4. 'QV) ,/4Y4. Q 0 Driveway permits <br /> (state, county,town) <br /> AD <br /> '110 DRESS: (� t <br /> 6 * Os 1�C� i\GC t-c.,(- v` W ❑Sanitary permits <br /> CSM: LOT / SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF RENIEW <br /> PROJECT QES�(RIPTION: i _;% ,'<;' ,.,:.5.; � - <br /> Aar \A l " 0 cb s (4 , -� Zoning Dlstnct r <br /> []This project is a new building or structure. s { r <br /> Permitfed User ; , <br /> his project is an addition/alteration to an existing building or structure. _ �, - f <br /> SANITARY SERVICE: PERMIT NUMBER: _ 1 RuralAddresstin - <br /> EWER [EPTIC `{new/exlstmg) <br /> a <br /> HEIGHT IN FEET .� NUMBER OF STORIES: (Not including basement) t - <br /> I c634- O tU E ❑ Wetland/FloodplaLnI <br /> «� Shoreland(attachment) ,' <br /> AREA TO NEAREST SQUARE FOOT i � <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ®� :.. - t <br /> BASEMENT 1ST FLOOR rr�� Y r E S}onuonttrol m <br /> \�d c . t 7 Cs 4, TOTAL SQUARE FOOTAGE: 4, = slopes d14,A,bance _ <br /> rY..,, «.. 4sTi�vC.ti--3' 7�ry y <br /> 2ND FLOOR 3RD FLOOR f iitig"IpAssy`. <br /> C.� 3(vO rte- w '�� „ter, <br /> _� Reviregfoeatk:f SUlvey <br /> ESTIMATED CONSTRUCTION COST: = --' '` " " ion <br /> , ♦ ♦ .,i ♦ ♦ QQ�� /� �t -and-avallabfe options <br /> (Please round to nearest dollar) 'p `J d ` 00© ,00 - t <br /> 7C <br /> -6 1SZ <br /> ' 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes Olo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ( 'es ao DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? -es Olo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes gab <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) [Yes alo 126-On't know <br /> 7. Is this to correct a violation? Yes gtdo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -4 —► <br /> 545-112(4/08) <br />