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L -G Erie 7 ' 7B <br /> , . /-ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION OF ICE USE ONLY <br /> OWNER NAME <br /> i - • - Ocrw A /1 I It t4 N7 Zoning,District <br /> OWNER ADDRESS (Number,Street,City,State,Zip) n�// _ <br /> //, 4 - , 3S-G V `� ' /r' • C-3532' rmitted Use? <br /> PHONE E-MAIL ADDRESS <br /> Tel ' "marling Status;CUP;. <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Restriction;•CSM <br /> AGENT NAME CONTRACTOR NAME Variance(# -) <br /> /1/eycd„.J , v,/Itces ?Z.-4X- y 6 wsai., /3,i,/elf(/fS 7/✓c . , <br /> AGENT ADDRESS CONTRACTOR ADDRESS ai"-:---Site Plan drawn to scale <br /> //O 40 f eke_ 5-7(- S v,f f a /10 B.rA-f kr s 7`- -5 v, f f B and includes dimensions <br /> (City,State,Zip) (City,State,Zip) <br /> �/I!vwa k E ✓I. s-33--,-7 Lt/Av,vt,f fC A/,Z 5'355 <br /> Site Plan".including location <br /> PHONE PHONE of well/septic <br /> E-MAIL ADDRESS E-MAILADDRESS lid`Setbacks , <br /> ffEwsc.v ,&,/a'fcs e7-05 •4' r // i cLA, , //f4'S 0 • N� <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) to Plan approval from <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: applicable township. <br /> ❑ PARCEL D //-3e.- 3 3, !// <br /> NUMBER 9 YGF7-a 9,? �,�.� <br /> TOWNSHIP: SECTION: 13d;"Rural Address <br /> /3a(sf6 / 30 1/4: 5 k 1/41/4: ski existing) <br /> ADDRESS: I <br /> (p(p rJ .1--£,eg y IQ y if Al Tgii4 I I ❑ Floor plans to scale <br /> CSM: LOT SUBDIVISION BLOCK/LOT ;- <br /> ,2 Qn,sto/ 64a ofw s ❑':Elevation of property <br /> PROPOSED PROJECT INFORMATION frontage drawn to scale. <br /> PROJECT DESCRIPTION: <br /> 5-1Aif/c fn"--, (y fifs,oes4../e£ IVewaypermits <br /> . ®This project is a new building or structure. (state,county,town) <br /> ❑This project is an addition/alteration to an existing building or structure. -- <br /> cmrp. '42 145 <br /> 'Sanitary permits <br /> SANITARY SERVICE: PERMIT NUMBER: (public,•rivet <br /> ❑SEWER IS SEPTIC r/f11 0 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) .ti a etland/Floodplaln/ <br /> / ,, r <br /> 02 5- - 6 l i8 / Shorelarnd (attachment) <br /> AR TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) 17"' rosionControl permit <br /> BASEMENT 1ST FLOOR: ;disturbance, <br /> �/ .7 1 TOTAL SQUARE FOOTAGE: (slopes', <br /> y G� filling/access) <br /> 2ND FLOOR: 3RD FLOOR: r=- C" <br /> eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ --► ♦ ♦ Oo O <br /> and available options. <br /> (Please round to nearest dollar) �ji �! / <br /> L- <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. There is a wetland or floodplain on or near the property? ❑Yes ®No ❑Don't know <br /> 3. Have you talked with the township about your project? ❑Yes ®No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ®No <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes ❑No a Don't know <br /> 7. Is this correcting a violation? ❑Yes ©No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► - -► <br /> 545-112(1/08) <br />