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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION CUST MER TO PROVIDE <br /> OWNER NAME ����__��� �,,A1 <br /> e"k FAriMe. M°seMevi-I) Zoning Status; CUP; <br /> OWN ADDRESS (Number,Street,City,Jr-.state,Zip) Deed Restriction; CSM <br /> 7377 &d al- Cres+ 1 scu.t, e_dy w ' -53s03 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (08 °- 1,3"'238Y Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME NAME CONTRACTOR NAME <br /> •Z c Lellesz gill Lefler' Cal 5{ liol 4❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ZOS L Ave, 730 Lo.,e, Cep- e-extr-+- <br /> (City,State,Zip) (City,State,Zip) ^❑ Setbacks <br /> I3 - k 141 s 3 9'i3 ,Scu K G,y r 5,3--S3 <br /> PHONE PHONE '❑ Site Plan approval from <br /> 60$ 393--3(oo1 6,c'9 -C`(3 -3867 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 2lener ) o.,I•CO, wjeite.r'z.Ei V41'too Cot-' -❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 050,bc 07_0,—J7pl a...0 K— i <br /> NUMBER a —I frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> I B 1/4: N W 'Rh: 5E Driveway peritsw <br /> OX�? � (state,count , towrii) <br /> ADDRESS: -7, 9 -I 'J V a ii _ <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sancta <br /> Z Natkl,16wk j;eids (publi , private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> IUew Ifom.e, oning District <br /> . EfThis project is a new building or structure. Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 0 Address <br /> [)EWER PEPTIC , "1 g—d'01(0-00O(Q% (new Xlsting) <br /> HEIGHT IN FEET: ) (,l NUMBER OF STORIES: (Not including basement) <br /> -4 (T.o, FooTIN4 7o RagF Frik <br /> Z LE-Wetlnd/Floodplain/ <br /> Shol-eland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) "` <br /> BASEMENT: 1ST FLOOR: ErosiohControi permit"" """ <br /> ,C aZ '7 /_-7 i j TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: `IO 3RD FLOOR:4 fllhn�laCC @SS' <br /> Ce ��I d iew Location Survey <br /> ESTIMATED CONSTRUCTION COST: //�� ;yl and available options. <br /> (Please round to nearest dollar) ♦ --► -�► ♦ ♦ -∎ `7 ,cc <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? gYes END ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? [v] es ❑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# (1Ih1 I ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ties ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes [*o <br /> SVk.' u,_00000 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -� -0 -+ <br /> 545-112(4106) � r 30 .75,_ <br />