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+ <br /> ( � r I .K rc, s #s -Tl7NA4 = 932 1022 Z <br /> • <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> Fe/VII " Api) 4141-6 <br /> PROPERTY OWNER INFORMATION CUS MER TO PROVIDE <br /> OWNER NAME <br /> ,H 4 c essefe Zo ing Status;CUP; <br /> (Number,Street City,State,Zip) Restriction;CSM <br /> YWNERADDRESS <br /> OME P $i tii�y `�2 i e,2c�cc CJ, 5 3593 vvvVariance(# _) <br /> OME PHONE CELL PHONe E-MAIL ADDRESS ,/ <br /> '�' /71‘, _ T _ 'J Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATIONd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 4},Q i 7e /46-4.5 Ivey w A-t- /-1626 HFi arSitgPlan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> /V8??1/4/,44 cey View iI /L't..374/ 4'At c y" V, red <br /> (City,State,Zip) (City,State,zip) e sacks <br /> P/Lr EK%G c,*z r/s 4,1/ 5 35 7.V PHONE 6M-at/5 �1/ 5 35 7`� l <br /> Ian approval from-4( <br /> Op O8)`-“N-191 3 (6aegi) `//c/- /513 Vapplicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> e.."-i'//TE i/'i/LOn/C`'€i 110r.41/7/t .CO A./ !c'/.//Te-rrn,e,ve c•- .LC,J plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: t'ev ' n of property <br /> N PARCEL �. �o a drawn to scale. <br /> NUMBER ,"4/0507 -+�N- -tt /4—/ 2x .3S./ g <br /> TOWNSHIP: SECTION: <br /> /C5 ��/P/ os E G 2 _ 1: 3 C' '/+/: Al J y permits <br /> DDRESS: te,county,town) <br /> A616 51n 7-6 wY 9 ._ vr''c+I a (.z ; .6, 55''3 m Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: SF R- <br /> R G pc 4C,e 6:741 D Aicesi LTC /f c�1E= W/ -.-1 A'c tci ,-/o -y t' --Zoning District <br /> . -TThis project is a new building or structure. [2, Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ..14 Rural Address <br /> ❑SEWER SEPTIC - > 5o 70 (new/a��t j' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) �Y - <br /> Q.C• ' i i Shotre a l(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: ErosionControl permit <br /> N//om_ .2 0/6, �' .../g2,. z j TOTAL SQUARE FOOTAGE: (slopes,disturbance, <br /> (t filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 5 /36P O' ''4 i Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -� ♦ -� ♦ ♦ co and available options. <br /> (Please round to nearest dollar) $ /35 coo. <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? ❑Yes ®No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ®No <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 a No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 4,No <br /> APPLICATION MUST BE SIGNED <br /> 5112(4108) (Continue on Back) -► ■ -► <br /> • <br />