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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 /> K P.A-is. 0 �—' /- Ld/iLytf btu-a y,J XZoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,state.Zip) �j �(��['�'ry / Deed Restriction; CSM <br /> VSS Un 1'br V ey ��{ ` ""E-MAIL 0 SS .S-35/.S-- <br /> Variance(# )■ <br /> HOME PHONE l'CELL P 761-25-2-0 333-1.21 't l / 1 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site Plan including location sx, <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State, (City,State,Zip) Setbacks <br /> PHONE PHONE >k Site P}6n approval from <br /> app able township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpi/accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NU BER: CU NT N ACREAGE: Elevation of property <br /> y <br /> J PARCEL frontage drawn to scale. <br /> le.NUM BER ` r J 07� -_ 3/I �'G 1 s acres <br /> TOWNSHIP: / SECTION: <br /> CASs P/041.5' 5' 7 IA: SW '/4'/4: S1/.) ADrivewa permits <br /> ADDRESS: 1ll n '(stat unty,town) <br /> l2SSL)iii� U 4.11ei 4/ Biac�Ea,* c,�.-5-3S/S anitar •ermits <br /> GSM:���� LOT „le SUBDIVISION BLOCK/LOT <br /> (pu• c,pry <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: 1/ / <br /> ci m 'i i ft7rhail/TN-01i fi decJe, `Zoning District <br /> ❑This project is a new building or structure. ,Permitted Use? <br /> St/This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE. PERMIT NUM R: TRural;•• ess <br /> ❑SEWER SEPTIC 1' `} -'/ A/ �, (ne fexistin•� <br /> HEIGHT IN FEET: NUMBER O STORIES: (Not including basement) <br /> I 3 ' Wetland/ oodplain/ <br /> Shore) d (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: y ErosionC ntrol permit <br /> 377 j TOTAL SQUARE FOOTAGE: j \(slope disturbance, <br /> fillip ccess) <br /> 2ND FLOOR: 3RD FLOOR: 37 <br /> Review cation Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ Q� and a liable options. <br /> (Please round to nearest dollar) $ i 'COO <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes N'No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 'RI No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 2-Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 CEIVEDs allo <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 al No ❑Don't know <br /> 7. Is this to correct a violation? AUG-2-1. al y Yes LJ No <br /> DMECOUNTYPLANNIN G&DEValetlitlifoN MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br /> ♦ ♦ -♦ <br />