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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVE <br /> OWNER NAME ,�A'�_� /�i� �)( - � <br /> �"%� IC.�(�{�17��1� Zoning Status; CUP, 1 <br /> OWNER ADDRESS (Nu er treat,CJty,State,Zip) O,-t/€ Deed Restriction; CSM/ O L0 <br /> 9 oa '1dI n /4ZV2 4 ( 59 Variance(# ) <br /> HOME PHONE ELL P ONE E-MAIL ADDRESS J <br /> I -4'-4- 63-04157 AI Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CO RACTOR NAME <br /> � nic/6".s�k ` /,9 „adder Sit- ' - - ding location <br /> AGFNTaDDRESS ` .. CONTRACTOR ADDRESS if well/septic <br /> 7 O Oco /ai. / E'- c'_- �� <br /> (Ci , ,e, 'p) (City,State,Zip) , Setbacks 4 ,�ef <br /> I dfA(e- b Sa we_ <br /> P NE PHONE G�Site Plan approval from <br /> 608 1 �1�Q� \6�ene J applicable township. NIP Co <br /> - AILADD ES�"T'� E-MAIL ADDRESS <br /> !'d 0 IA' / \SQ1ylE? <br /> Floor plans to scale <br /> 7 <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ,�,( "i, <br /> PARENT PARCEL NUMBER: CUR TZONING: ACREAGE: / u Elevation of property ,r �,(j <br /> Li PARCEL 1 2 ' O frontage drawn to scale <br /> NUMBER Cr?O_ Z.o14-` (Do 0 \ 1 ` © S <br /> TOWNSHIP: SECTION: <br /> VP-rd ? - <br /> 1/a: /Y: ' rivewa •- its <br /> (state a Nivr own) <br /> ADDRESS: Y 6-co)(� i �' i C 0 � � 4 y 4 , f � w t Y VI Sanitary •:. •■its <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (pub!' ,priva,=) <br /> PROPOSED PROJECT INFORMATION <br /> STAFF RV E <br /> o PROJECT DESCRIPTION:n )5 f� �� 7`a //9 r°l!den i — Zning Disrico t <br /> „. .: :,.,.. l� <br /> . III This project is a new build g or structure. Permitted Use'? <br /> - . <br /> ❑This project is an addition/alteration to an existing building or structure. gP k <br /> .� R I Address <br /> SANITARY SERVICE: PERMIT NUMBER: i`�' � <br /> existingi -i; <br /> ❑SEWER ®SEPTIC , 3 O <br /> HEIGHT IN FEET: / �) NUMBER OF STORIES: (Not including basement) J ' a �� <br /> oodplain/ <br /> 4\3 — 9 �� ��P �Shor ®® attachment)i <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: Err r611d∎S IttUI iirlTlit <br /> 3 4_65 g 4 / 4, TOTAL SQUARE FOOTAGE: j (slopes,Pdisturba ce,�t 3 r <br /> J � lrng(access <br /> 2ND FLOOR: / 3RD FLOOR: ''�� `4* v l � s <br /> 5.56 �� 4->� Review Location S <br /> ESTIMATED CONSTRUCTION COST: O and available O tons � �- <br /> (Please round to nearest dollar) -► �Lj�) � Q <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 El No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? EYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Gs 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? (s-- -'- a ❑Yes JK1No ❑Don't know <br /> 7. Is this to correct a violation? El Yes rig No <br /> ` 6Z3. / sue <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />