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Rug 27 08 01 : 37p Elgin Mtso 8472899630 p. 5 <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWNqR NAME U 6. 3r& U_ Zoning District <br /> OWN ERRADDRESS(Number.Street,City,Slate,Zip) _ <br /> _ t,_ e7b#Acdt6e6tAstoi ,'t '/ _ ❑ Permitted Use? <br /> E•MAIL ADDRESS <br /> $47-SI7-o&to <br /> ❑ Zoning Status;CUP; <br /> AGENT INFORMATION <br /> CONTRACTOR INFORMATION <br /> AGE E CONTRACTOR NAME Deed Restriction;CSM <br /> Je nu f 'hft"eve>l _ 46,1-.Jo,. 71G%e - Variance(# _ ) <br /> 336 Af�/lor� �t, c `TORADD S U Site Plan drawn to scale <br /> o. /L t & <br /> (City.state,Zip) ( s ate zip) and includes dimensions <br /> -U.',&►-ton W 1 5-3532 AC i t ko7 <br /> PHONE '�— PHONE C] Site Plan including location <br /> (8 7)10-1-4(46 'Oit b%/ of well/septic <br /> E-MAIL ADDRESS E . LADDRE ❑ Setbacks <br /> Idal(0 to <br /> PROPEIRTY/LOCATION INFORMATION (http:iraccessdane.co.dane.wi.us') U Site Plan approval from <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: <br /> ❑ NNUMBEER f 05/A a$:� p)' I_ 6-3 „ -4!)(p applicable township. <br /> TOWNSHIP: SECTION: <br /> 0.5- s� _ _ j4__I ,/,.: Ai 10 ❑ Rural Address <br /> ADDRESS: (new/existing) <br /> CA6C 5 &/ik- <br /> ❑ Floor plans to scale <br /> CSM: LOT 'SUBDIVISION p BLOCKILOT <br /> /. S yz,l.tfic Etagenn3,60 ,• ❑ Elevation of property <br /> PROPOSED PROJECT INFORMATION frontage drawn to scale. <br /> PROJECT DESCRIPTION: <br /> F.,it--OF-- )__8 AM-1? 4 S4J b( S 1V1 P-'elAr-S <br /> - <br /> F2 —• • ij Driveway permits <br /> . LJ This project is a new building or structure. 6t:9-( (state,county,town) <br /> "This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Sanitary permits <br /> a <br /> seweR la SEPTIC <br /> (public,private) <br /> HEIGHT IN FEET: - Y NUMBER OF STORIES: (Not including basement) <br /> I ❑ Wetland/Floodplain/ <br /> `A - �•� ... Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) U ErosionControl permit <br /> BASEMENT 1ST FLOOR: T p <br /> 15 i, +TOTAL SQUARE FOOTAGE: +, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: 'W p �Illing/aCCe$S) <br /> f l7 L i Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -0-0-0-4. and available options. <br /> (Please round to nearest dollar) ♦ �� — <br /> 1- The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes ❑No U Don't know <br /> 2. There is a wetland or floodplain on or near the property? 1.0-Yes U No ❑Don't know <br /> 3. Have you talked with the township about your project? Yies ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? a Yes ❑No <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal#_____) (leave blank if none) <br /> 6. Is a location survey required? El Yes 0 N t'6on't know <br /> 7. Is this correcting a violation? ❑Yes Itd' lo <br /> APPLICATION MUST BE SIGNED <br /> 545.112(1/011) (Continue on Back) y -00 -• <br />