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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME I <br /> Marl, 4t L Zoyng Status; CUP; <br /> OWNER ADDRESS (Number,Street.City,State.Zip) D ed Restriction; CSM <br /> I t4 q LO&-S tt 4M. >�-�„ , S'�'btAi 0�6-,., tt- + S35'5T /riance(# ) <br /> HOME,HONE 'CELL PHONE E-MAIL ADDRESS / <br /> -i`4'42344 I fQ� *11" —6Z I t��,►,'14--€1-1 6414"A(��,C-" Q Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions 2 <br /> AGENT NAME CONTRACTOR NAME <br /> Covtvle-IA Cca sit S4.yuLa,t„v‘ LLC_ ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS 9f well/septic <br /> 2-1 P.,y4- 1 �-y <br /> (City State,Zip) (City,State,Zip) [ Setbacks <br /> SGi/he-S J i(ke_ t ( S3' i cg <br /> PHONE PHONE ❑S e Plan royal from <br /> (o EIS 125 s-' gi LF 3 pplica township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> cC'vtv'atAC°OS{,iac11 y ,f((A, ,,,,c.;1. Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn ❑Elevation of property 2 <br /> PARENT RCELNUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER -- ^1 Z-0�3- 510- c0 4 ! frontage drawn to scale. `PARCEL CC) <br /> TOWNSHIP. SECTION: S N1 w <br /> 41 61(0 vi 0 -c56+411- '/4: -1a+a' WA: S-bei ❑Drivew ermlts <br /> ADDRESS: (stat , county,town) <br /> ItLt C5 Li;wNla, --. 2..1 t S4b Leis,k. , t wt 5 3� C 5 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanita ermlts <br /> I/(o 30 _ — (pub' ,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> r <br /> �l � t'f4 vv. 6 ks-c (c.6,-, qg x.3 ■ oning District <br /> . gThis project is a new building or structure. <br /> • Permitted Use? <br /> This project is an addition/alteration to an existing building or struc ure. <br /> SANITARY SERVICE: PERMIT NUMBER: ` ❑ Rural dr <br /> TTE.WEP. EPTIC i� (new/e sting <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> i")-, t ❑ Wetland/F dplain/ <br /> Shore) d (attachment) <br /> AREA TO NEAREST SQUARE FOOT: r <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: � ❑ EroponCont permit <br /> i4* j TOTAL SQUARE FOOTAGE: j (slopes,d. urbance, <br /> 2ND FLOOR. 3RD FLOOR: filling/a -ess) n <br /> 414 © t- <br /> � /(51.3D ❑ Review Location Survey \v\ <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ and available options. ' <br /> (Please round to nearest dollar) 421 Ql2 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ao ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Efres No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes No <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) DYes Eg o ❑Don't know <br /> 7. Is this to correct a violation? [Yes 2 o <br /> 4qc) —■APPLICATION MUST BE SIGNED <br /> + (Continue on Back) —►■..jt 545-112(4/08) Ir <br /> n e ecf - ,&/ 140 4- <br />