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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME /117.1 . <br /> Cteq\cy.t\ D.A< LL c Zoning Status;�Gl.IPJ <br /> OWNER ADDRESS (Number,Street,�ity,State,Zip) Deed Restriction;CSM 4"(7/ <br /> (?3 1 CAbA UG►1\tl Vk. �hc.,WT 535x9 Variance(# l29�7 ) <br /> HOME PHONE CELL P NE E-MAIL ADDRESS <br /> v4-415-350? tSchvw....A- ClewriCatt•• tnets.c4vA GSite Plan drawn to scale , ' <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions � � <br /> AGENT NAME ` CONTRACTOR NAME <br /> Eck �C ...,Mo.,n". Fick■ $cb}lners IffSite Plan including location �,/� <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic �1' <br /> 211 N, Wv,ttricwr, 5i- &I00 151-X.. g(% 2 / <br /> (City,State,Zip) (City,State,Zip) a Setbacks , <br /> "Tovv.sov. CCee,V. ,Wt- `)3031 11,125i'ScAt ft, 54(p(9 9 <br /> PHONE PHONE OS ite Plan approval from /4' <br /> cool-y.15- 2�f(p$ (.08-,(p1— applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> estkv.."4„AAQdeirSwey fivtrs.0" o.icliA e k.kmbr.og. C ovv TiFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑PARCEL �l Q u \ frontage drawn to scale. <br /> NUMBER A. A •j •' — t?..--2400-0 A-V t .Z lot t c��1'i <br /> TOWNSHIP: SECTION: <br /> VICv no. —rown51n1t 3 I Y.: 5W Wit: Nw Driveway permits <br /> ADDRESS: ` p� (state,court ow <br /> 03x1 Cvkbo► VOA e' �►At , for 5���� sanitary . y:-•'ts <br /> CSM:' 13-1 LOT J SUBDIVISION BLOCK/LOT <br /> ... (public, AmireAl <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: di <br /> Rece;0 �N1la►l'��' S6 / 2 2 ) �Z / `'14 k Kk-• , Zoning District A �S <br /> . rThis project is a new b ldin or structure. J /Q <br /> p t g ���' � �°' q Permitted Use? /Mil/ <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Ar Rural A• ✓�3 <br /> EWER PEPTIC 0 11-N (new - ! 'O r <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 11 1 91I 1 We - ,•/ loodplain/ <br /> AREA TO NEAREST SQUARE FOOT: = oreland attachment) WA <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> E <br /> pat rosionControl permit rr- c <br /> BASEMENT: <br /> N I 1ST FLOOR: ,� <br /> l 34 j TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, fQ <br /> ` �l filling/access) r / <br /> 2ND FLOOR: ��� 3RD FL <br /> OOR/A I 34141 <br /> Review Location Survey /v <br /> ESTIMATED CONSTRUCTION COST: ♦ -► ♦ Q� ! , + and available options. �/iL <br /> (Please round to nearest dollar) $ 1 D0 !J <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [ 'o DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes to don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes I=11\lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? / t'es Lilo <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 Eillo DDon't know <br /> 7. Is this to correct a violation? Efres 113Clo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► <br />