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SUPPLEMENT-o Ylleb App:# . <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> pROPERTY=O WNEFt INFORMATION - ..4 .X"' )-112:0 4`? CUSTOMER TO PROVIDE <br /> OWNS NAME - <br /> arc d! V U'e �' f4_,/ ['zoning Status; CUP; <br /> OWNERADDRE/(Number,Street,City,State,Zip) �.J 17 , <br /> �f/ �f�� Deed Restriction;CSM <br /> 2-5- S G cv/ ec.i � /TU/ �-S Z Variance(# ) <br /> HOME PHO ELL PE. ONE E-MAIL ADDRESS <br /> (o Y / •2.S 0 Site Plan drawn to scale <br /> AGENT INFORMATION r::,,-:T ` CONTRACTOR,INFORMATION , .�;� a t, and includes dimensions <br /> AGEN NAME CONTRACTOR NAME T <br /> /r Cd/'Sfroc,t o,-, r cen5 / f/0f- ❑Site Plan including location <br /> AGENT ADDRESS Ura 1 f(e.i CONTRACTOR ADDRESS i ro • c/v Sot of well/septic <br /> _S C) pat I t-`L_ ((10 4c_ o eax�ly l <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHOI4E. PHONE ❑Site Plan approval from <br /> fog- 'et'-79/z-f - s Q � applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS • <br /> r A_ I:2---/—re Cc, _I/067`rc,/ c7 g.--. S « ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION_`(littp//accessdane cq dane wrus/) °' K Elevation of property <br /> PARENT PARCEL NUMBER: CURB{ TZONING: AC/RREAGE::,/ frontage v drawn to scale. <br /> N MBER 06 C-' !( !(� G1?691) /j-- -I' CCU <br /> TOWNSHIP: SE Ti N: <br /> ,/4. //4. El Driveway permits <br /> - e 7 "` �" (state, county,town) <br /> ADDRES : v <br /> c2.55.' 6c-�r V,t°w LN firr //ere& w� - -4-7 Z ❑Sanitary permits <br /> CSM: LOT 7 SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION - ::::::,:',..:::-.,*:":'::-":: ::=':::!:::"..i <br /> _ __ ;STAFF=REVIEW <br /> PROJECT DESCRIPTION _' '.T r s ` <br /> SCii&01 C/C�, <br /> _-0 Zoning D�I�stnct r( ' <br /> ' �This project is a new building or structure. - �� <br /> p I g � Per•mltfecj Use? t r- <br /> ['This project is an addition/alteration to an existing building or structure ' r! <br /> Rural Address <br /> SANITARY SERVICE: PERMIT NUMBER: ®� , r M <br /> [EWEI / SEPTIC (ne xisting) _ <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) .f /F ._// ❑ Wetlad loo <br /> dplalnn <br /> = Shorelan attachm <br /> ent) <br /> AREA TO NEAREST SQUARE FOOT = r. a- <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) • .�- ' <br /> BASEMENT: 1ST FLOOR 0 ErosionControl permit ;t <br /> Qif ��j/ ) 79-- 4, TOTAL SQUARE FOOTAGE: 4, slopes,disturbance <br /> 2ND FLOOR (i/71- 3RD FLOOR ^ �j //�� `>'V � Z r r <br /> // _ f`" r CC.JJ ( 1 / / t Revle i.7z0,8 tion SUnrey <br /> � '-4s� .. ���ia�r <br /> ESTIMATED CONSTRUCTION COST: Q —��-- :i and available optlonsY <br /> (Please round to nearest dollar) ♦ ♦ -I. --► --► ♦ $ 8n g:f0-} ZZ ,r ;: <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes TENo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Lives Do Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - Lives SIslo <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 EIN2 ODon't know <br /> 7. Is this to correct a violation? Wes jI,o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4 ■ -4 <br /> 545-112(4/08) <br />