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j.hr r. <br /> VP '?-:--1 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PRO DE <br /> OWNER NAME _ . <br /> •J0 SV Culp 1-r✓ lCt I O Zoning Sta s; P; <br /> OWNER ADDRESS (N mbar Street,City, e,Zip) Deed Re • n;CSM <br /> 1130 ' eCI To hi Ve._ VC rori t IA)] S 3 59 3 Varian (# ) <br /> HOME PHONE I C LL PHONE E-MAI ADORES? <br /> ,It ,' -627 (030 29/ 0S'15 .2. ,la I 'ThQI .tm Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> �bA cqfa\0.Li.1I i0.5on Thomas -ernes, LLB Site Plan inGu • g location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/se <br /> 7702 h vexf Trai j 77D2 a./very ir ;1(City, t , _ (City,State p) / etba <br /> AI odciI � "1/,L S,?66_2 PHONE oI n (, 1 S35la 2 Ite Plan -•p •`' •m <br /> ((Q0, 2-2-0 t.,01 2.0 t.,01 pt 2.2L) -to 39 I applicab / . shi•. <br /> -MAIL ADDRESS 'E-MAIL ADDRESS F,/ <br /> a .',a ' I,Sb►1`tf'1o41`C.tS/61l: a ri . t .1 It kJQSDn�'Ib _.! i' ,t a-� """ plans to <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) /� <br /> PARENT PARCEL NUMBER: CU RENT{ONI G: ACREAGE: Vation Of pr pe <br /> 0 PARCEL NUMBER 070 e.-Zb3-23'4-G ley i det;�l I G( 1 •7.5 fronta a dra Scale. <br /> TOWNSHIP: UV1 SECTION: <br /> Til ton ton 0� f►rsdd n 2d '/a: N lo '/h: $W Dri ve way pe i <br /> ADDRESS: (state,county, wn) <br /> 311 N C r J,w'1Q'i Pd,n4 T1 oil l 7 11�N'_'TL l� "�`�-- [Sanitary pe i <br /> CSM: LOT (,�+ SUBDIVISION BLIP. f OT (public,priv je <br /> • I '.Li PO • <br /> PROPOSED PROJECT INFORMATION STAFF 1EW <br /> PROJECT��DrrE��SCRR�IPTION: , <br /> Kiev) i'AA 1/ittin S15le kw' Iy ❑ Zoning i rict <br /> . SThis project is a new building or structure. LI PermittelUse? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: LI R al Address <br /> '(fir EWER <br /> J EPTIC _ S xisting) <br /> HEIGHT IN FEET: NUM. <br /> U ER OF STORIES (Not in�ng basement) <br /> Z8,5 2. L3 etland/FI' .• • <br /> D AREA TO NEAREST SQUARE FOOT: Shoreland (a - ant) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks o port e_s) ❑ Erosion O' •I permit <br /> BASEMENT 1ST FLOOR: CK? AG <br /> �/� `♦ 9 i_4 TOTAL SQUA F T E: (sio•--, • 'ante, <br /> ��OX►J n� '� �� 11► ± r� !JP j filling/. .-ss) <br /> 2ND FLOOR: 3RD FL <br /> I q go � 7 <br /> ❑ Review o %. - <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ and avail = •p•ens <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? CYes `o DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Oyes o EDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? s o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Oyes 15o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> ' . Is a location survey required? (see reverse) es a10 ODon't know <br /> 7. Is this to correct a violation? es o <br /> O <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -* -i <br /> 545-112(4/08) <br />