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C)1 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> UGYYICCS G . t'ot .,,��d>A ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City, Zip) Deed Restriction;CSM <br /> G(oc\ C ' 1 -i N Sit�c��ttyt WL G'' t� <br /> Variance(# ) <br /> HOME PHONE CEL PHONE E- AIL ADDRESS <br /> WS X43 3q j • 5i-3- 8 30 6 LiSite Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT AME CONTRACTOR NAME <br /> ` �,/ <br /> -(oli bQ 1 1 i1►1,� L "Site Plan including location <br /> AGENT ADD <br /> REtS <br /> S CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) d Setbacks <br /> ibuc�ll tar U)t S10( <br /> PHONE PHONE ❑ Site Plan approval from <br /> 6bq Zoi- 39 IL/ applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Yo(i 6011 r a i ;I -c pyy/ 2' Floor plans to scale <br /> PROPERTY/LOCATWN INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CUTNNT Z NING: ACREAGE: /� Elevation of property <br /> ❑ NUMBER OSf I -212_q 21�'- © ...Q t. z S U frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> n KIRK 1/4: 1/41/4. Drive units <br /> ADDRESS: (Star nty,town) <br /> (20a C41 {lwy iq `j D0C0t-,-Tb I'l UJ 35g1 ani -. •ermits <br /> CSM: LOT SUBDIVIS�N BLOCK/LOT <br /> lo O � --� (pu. c, •rivate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> '-"to fU S kd5 ) Q Ic 1-C Zoning District <br /> . rdEi This 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: ,Rur- L.. - s <br /> ❑SEWER ❑SEPTIC - (new 4iiiip <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) "r <br /> 7- r etland/Floodplain/ <br /> S oreland (attachment) ° <br /> AREA TO NEAREST SQUARE FOOT: (79n4 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> rosionControl permit / <br /> BASEMENT: 1ST FLOOR: gY� <br /> I (O +, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> CO <br /> filling/access) 11 <br /> 2ND FLOOR: 3RD FLOOR: <br /> ( (o 0 <br /> 1aeview Location Survey <br /> ESTIMATED CONSTRUCTION COST: � 'o nd available options. <br /> (Please round to nearest dollar) " ' --1. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 'Wes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes callo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 4 Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 5dYes ❑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? (see reverse) CI Yes ❑No Don't know <br /> 7. Is this to correct a violation? UYes *o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► ♦ -+ <br /> 545-112(4/08) <br />