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SUPPLEMENT#o Web App;# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> pROPERTY<OWNER INFORMATION s :.-� s1 <br /> - .�. _ .. _,_}._, CUSTOMER TO PROVIDE <br /> OWNER NAM <br /> 76, 'h' 60 6E7E4. oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip)VV/". ' / Deed Restriction;CSM <br /> ` 3657 tick./4,thd svz o - Ve/al o Wi 5-3Cf3 Variance(# ) <br /> V/". <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> - c77 25 S" If • r / /6fr' 77t2 kQD C'' ' Plan drawn to scale <br /> AGENT.INFORMATION. `CONTRACTOR INFORMATIONN a e76.:f; and includes dimensions <br /> ' AGENT NAME CONTRACTOR NAME <br /> Plan including location <br /> AGENT ADDRESS CONTRACTOR DRESS of well/septic <br /> • <br /> (City,State,Zip) (City,State,Zip) ligyS backs <br /> PHONE PHONE ❑Site P pproval from <br /> app'. township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> Floor plans to scale <br /> :PROP ,RTY/LO CATION:INFORMATION= ( tt•.11- . ,•__ • ' � t �. Elevation of property <br /> PARENT PARCEL NUMBER: CURRENTZONING: ACREAGE. <br /> PARCEL R_] 1 ei� . frontage drawn to scale. <br /> NUMBER .�0 03 0 1 q 099 1 (� 1 <br /> TOWNSHIP: SECTION: <br /> y"- j O� /4: /4/4: 0 Driveway permits <br /> ADDRESS: -�7�—�. J <br /> C (state,county,town) <br /> \j `-!i 2C,C11/? ❑Sanitary permits <br /> CSM: LOT St4BDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION `" <br /> - - � - STAFF REVIEW <br /> PROJECT DESCRIPTION: )sXIS -- s <br /> Bi A Aaer f hv, G✓.�//Lw.ry1 LAa.lse„ pt./ ,a�/S1)/Gt_ -D Zoning D tract rp <br /> This project is a new building or stru//cture. } <br /> ' � p I g �� Permitted Use? �� - <br /> EIT-his project is an addition/alteration to an existing building or structure. `° �' <br /> pl RuralAddress4y <br /> SANITARY SERVICE: PERMIT NUMBER: .� ^' <br /> EWER FAEPTIC s(new7ezisting) -- s= <br /> !, / HEIGHT IN FEET: ! NUMBER OF STORIES (Not nGuding basement) - <br /> V / ❑ Wetland/Floodplain/ <br /> ;� Shoreland_(attachment) <br /> AREA TO NEAREST SQUARE FOOT '_ g f a . <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ® F ,- <br /> BASEMENT 1ST FLO �< O Er814=Kontrol permit <br /> j TOTAL SQUARE FOOTAGE 3 slopes,disturbance <br /> ���•••---��� 1in filling7acceS-S i <br /> 2ND FLOOR 3RD FLOOR f4 141—� 6� 4 t { <br /> _ Revielkntatiop SUrvey <br /> ESTIMATE CONSTRUCTION COST: d C and available Options` <br /> (Please round to nearest dollar) ♦ ♦ -► -+ -•. ♦ $ /1/aOv F,f E,, a_-; <br /> ' 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Lilies E to LiDon't know <br /> 2. Is there a wetland or floodplain on or near the property? LiYes No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes flo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes [ to <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 QKIo LiDon't know <br /> 7. Is this to correct a violation? Efres ao <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► -I► <br /> 545-112(4/08) <br />