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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> M/C HAIL /rl u LC, ❑ Zoning Status- P; <br /> /INNER ADDRESS(Number,Street City,Slate.Zi)) Deed Res . ion;CSM <br /> ,S7 Ca ix r+ u ��LLcu' E W/. S3Sd 8 Varia (# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 408's .7 -39160 og;ZiS-3$7.S N Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> 1 (X-E T NAME <br /> C�� CONTRACTOR NAME <br /> M (1 O� 1' ❑ Site Plan including location <br /> A NT ADDR SS l CONTRACTOR ADDRESS well/septic <br /> N(0?) p ni Ni N ' 't 41101 (pl <br /> (kit) slag, p) <br /> (City, Zp) Setbacks <br /> v- M� Ce"t o 14)( v/' "l O '� I b) i S 31v ❑ Site Plan a val from <br /> 1JQ D i) 1. 21 51 ' (100(b)�i'� 2' 1 pli township. <br /> E-MAIL ADDRESS E ILAD <br /> l i .;�AA art p ' �j.n / lif we 1- r Yid- Floor plans to scale <br /> PROPE■ITYILOCATION INFORMATION (http:Ilaccessdane.co.dane.wi.ust) '11-: Elevation of property <br /> PARENT PARCE NUMBER: CURRENT ZONING: ACREAGE <br /> ❑ <br /> PARCEL O4t e601'343 IOW-• /).-1 )( 40.5 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> '? 1 p - J'�W LI Drivew ermits <br /> ✓ ADDRESS JA V 1 ��4. 7 ��4��0. <br /> ` - , , F , (s unty,town) <br /> WI C€oONT vii way b6( U " Sanita its <br /> CSM LOT SUBDIVISION BLOCK/LOT (p rivate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: /1 5 X 0? oning District <br /> . Cia'fhis 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 <br /> ' <br /> r- SLvef — �----,__ Rural `a <br /> (new/ ) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> a? ' <br /> Ave - 18, 6 / ❑ Wetland/F p IN <br /> (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ErosionCOntrol permit <br /> BASEMENT: 1ST FLOOR: 5-6 j TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> /1/ 4, ' filling/access) <br /> 2ND FLOOR 3RD FLOOR: <br /> a 9 2"' ❑ Review L..:lion Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ¢ .r"�� D�� and. e :OptiODS. <br /> (Please round to nearest dollar) $ VJ <br /> 1OO �. 0 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 1■ es ❑No ❑Don't know ^ <br /> 2. Is there a wetland or fioodplain on or near the property? Y,Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement?.... . 0,NN5' <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes L�'No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank/none) <br /> 6. Is a location survey required? (see reverse) ❑Yes No ❑Don't know <br /> 7. Is this to correct a violation? ari es ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) • —► —► <br /> 845-112(4108) <br />