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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME y� <br /> /I- 445 /✓ 1r`'d—i-e Ie#ff I� <br /> OWNER ADDRESS (Number,Street,City,State,Zp) Lt Zoning Status;CUP; <br /> Z5/O /!,,-n .0 live /9044 fvn �� ��70 V Deed Variance Restriction;CSM / 3 <br /> /��i,sJ � Variance(# ) <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS <br /> 60F/—.22G) FISY` 9 A,-,Fs • ,i"�- a el/v"4-1,--G5 Site Plan drawn to scale <br /> ) <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions ( <br /> AGENT NAME j CONTRACTOR NAME <br /> 7d 6- r a74,c s '—I C `�'� %s4 /`�a>"Lars Site Plan including Iocati efu?/1 <br /> AGENT ADDRESS / .di,3 CONTRACTOR ADDRESS // of well/septic <br /> 15-Y6 GO/7(')- -fe enfes-- •Or, ‘ ti-Z ‘ "Is/'C 5' /�'�l -7� <br /> (City.State,Zip) (City.State,Zip) Setbacks 3V//t9A <br /> Wei f 1} G✓I". 5-30 VS"— .?;i'ts:y, 07101:1i/z/'4 C✓,t- /V/� <br /> PHONE PHONE Site Plan approval from <br /> 2 6 2,-33--,1 S'q L Q 5-79—/d-2-d applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> ke @ l'u Z e-f i •cc, Floor plans to scale 1 2 <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: gl Elevation of property <br /> PARCEL o 3 Vole 7O Y 25,E 25a -'/ d.Z , e.,- frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECT10 <br /> i d c1 k foil '/<: J W '/.'/e: /t) riveway pe <br /> ADDRESS: (state,coup tow <br /> e e'' 44/H /pal <br /> CSM: LOT SUBDIVISION BLOCK/LOT permits <br /> �_ ubl mate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: 10.1.01/ ,,��,��// 'Z /o �j <br /> Re--71 a4-•'y) fix,5-1-,fs., 5,94 —.Sc:7rre,5/.z UCH Zoning District ` <br /> . OThis project is a new building or structure. 0 6 Permitted Use? I✓c_ I I S i `r & <br /> NThis project is an addition/alteration to an existing building or structure. � (; <br /> SANITARY SERVICE: PERMIT NUMBER: / RUraIA•g s <br /> EWER PEPTIC (new ]► <br /> HEIGHT IN F NUMBER OF STORIES: (Not induding basement) A� <br /> /` > loodplain/ /1/ <br /> AREA TO NEAREST SQUARE FOOT: / horeland)(attachment) ,►2 <br /> (Outside dimensions induding unfinished area,atta p garages and above grade decks or porches) �J <br /> BASEMENT: 1ST FLOOR: s �,I (�-trosionControl permit <br /> OTAL SQUARE FOOTAGE; ,l (slopes,disturbance,3 7 filling/access) l <br /> l <br /> 2ND FLOOR: 3RD LOOR: / <br /> eview Location Survey,// <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ t /�Cd U p and available options. ,j,� <br /> (Please round to nearest dollar) i <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes D10 ®Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes No ®Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes _No h kss <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes J'lo )4 <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) DYes lab [on't know <br /> 7. Is this to correct a violation? Oyes alo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> sits„z pve> j 32 i/ !/ / 9 (/ <br />