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64 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME IN��pE--,�� <br /> VE12 - M. TET Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> \ 11 }..1F. gt_o Pp JDDLE�Ta-r.)1 a S3SC'2 Variance(# ) <br /> `/ HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> „►$--g31''1%1 60%- 93$-2R1y r ' e cAvur}er- ■,71 L <br /> Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> *Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) --_ Setbacks <br /> PHONE 1 PHONE S Site Plan ap oval from <br /> pplicab ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> C r pl to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) I at1 f property <br /> PARENT PARCEL NUMBER: CURB v0 <br /> ZON NG: ACREAGE: P P y <br /> ❑ PARCEL -7 fro a drawn to scale. <br /> NUMBER O-1°� o ry T r 7 / I. 2 <br /> TOWNSHIP: SECTIO : <br /> D '/a: s '/1/:v kJ Drlvewa ermits <br /> ADDRESS: <br /> ,county,town) <br /> 1 ._N: 6h1 D 1.p� <br /> ¢4 AlfrDUNITO Gr .S3 S6 2 <br /> CSM: LOT SUBDIVISION BLOCK/LOTSanita permits <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 10' x 181 PECK- A'DD�'7j To 16' 12' pEC - cacZoning District <br /> • LI This project is a new building or structure. [permitted Use? <br /> 21 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBE • Rural Add <br /> ❑SEWER XAEPTIC lI (ne <br /> HEIGHT IN FEET: NUMBER OF S'TOI?IES: (Not including basement) <br /> 114/4e41 is 1 Wetland/F plain/ <br /> AREA TO NEAREST SQUARE FOOT: Shore! d (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: EI OSIOnCO rol permit <br /> 1 CYO l/� +, TOTAL SQUARE FOOTAGE: + (slopes, turbance, <br /> 2ND FLOOR: \V 3RD FLOOR: filling/ SS) <br /> 3/—,n) <br /> ESTIMATED CONSTRUCTION COST: Review L tion Survey <br /> ♦ ♦ ♦ ♦ -i 6 ■aD and av able options. <br /> (Please round to nearest dollar) $ d <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. Is there a wetland or floodplain on or near the property? Li Yes VNo LI Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes ❑No Mo,,s-Q- <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? BYeS Li No (6`"* it^ ) <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey re - ed? (see reverse) ❑Yes *to ❑Don't know <br /> '" 7. Is this to correc a violation? ❑Yes OW <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) --0. ♦ -► <br />