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K,E5O <br /> ZONING PERMIT APPLICATION www.countyofdane.com EM=C=Ti! <br /> PROPERTY OWNER INFORMATION CUSTO ER TO PROVIDE <br /> OWNER NAME <br /> 6010‘b‘id I- TA talc)1 rn/°/2-fy oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> .2 84/ 6,46 /',Ad 6fvt r7o v iJD5 t,-'X. S 3 5 / 7 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> dot at/r.- /) to Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> /it N5EN A 1 !Mips .jve. H6-A,,sEty a,rllfo s 1ive- S' Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> //O t3/f+lr , $7 surf-J- 8 //D 64 k£rt- 44 5vitf <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> (,i/.avNA k61 it./Z. 5-35-`l'7 6t%✓ivA /FE Gc141- . S-3S-9 7 <br /> PHONE PHONE ❑Site Plat a'.4'.1 from <br /> 6p IY9— 1/71L /c/-.--f — yy3t applica,I- ,• nship. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> hE1vs6.Av$vi//€ -s Q.-7AS . 4/it heivsE,vb,,,/4,es•GTos.Ng9' loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:I/accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: levation of property <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER 6466-07 I-9 yvo-cp a z 7 .2.-/7 <br /> TOWNSHIP: SECTION: <br /> 1,3�uE ly?ov`v� 5 ©�f '/<: ivf 1/1/1: S'A./ ❑ Drivew- p=�'i' <br /> ADDRESS: /},/ (state, ,•. , ', .wn) <br /> 1t i 6 .he • A Ali rn! eH2O$ Z . 3 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanit-', •'at <br /> /04/ (publi,, •- at <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 3-56#5-9,0 1 o,v /°o,t L/oaSfaver`se(/ <br /> 0A/ e icf'.)v j /40/./ ##e-r U Zonin !strict <br /> ❑This project is a new building or structure. ❑ Perm ed Use? <br /> This project is an addition/alteration to an existing building or structure. -� <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Ad ess <br /> DEWER - (new/e Stan ) <br /> HEIGHT IN FEET �,�� r NUMBER OF STORIES: (Not including basement) <br /> D Wetlaloodplain/ <br /> Shor I nd (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) -t <br /> BASEMENT: 1ST FLOOR: J Erosion ntrol permit <br /> /VV ,1 TOTAL SQUARE FOOTAGE: j (Slop S disturbance, <br /> 7 7 filling cc ss) <br /> 2ND FLOOR: 3RD FLOOR: <br /> /y' U Review ovation Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ -► ♦ ♦ $ o c and v able options. <br /> (Please round to nearest dollar) 37, 5'63 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes ENo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies a. ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Ries ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ao <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) ❑Yes EN. ❑Don't know <br /> 7. Is this to correct a violation? Dies HIClo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -* — -► <br /> 545-112(4108) <br />