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1© 9C '3t , `1- s , ► c ? c I <br /> is ? 9t - Lc. - I <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU OMER TO PROVIDE <br /> OWNER NAME <br /> 2 - L Pooper-his LL(r Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street City,State,Zip) Deed Restriction;CSM <br /> aSg ST S, 4 z M'- i �c. IN) S35"1.L Variance(# ) <br /> hleMe•PHONE CELL PHONE f E-MAIL ADDRESS <br /> 1 [ 1�'u�-S' c (911-2.6-6 -3 !.. Ze,i , i T_,,;..1. ' ! $ . ye. , ��JI2 e <br /> Plan drawn to scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME A <br /> 2 t L ,P/De r S N'i� _ [ Site Plan including location <br /> AGENT d S �D�� 2 CONTRACTOR ADDRESS if well/septic <br /> C 1J <br /> (City,State Zip) (City,State.Zip) ❑Setbacks <br /> 1 4 1 1 0)&6 VA 5 3S- 1 L <br /> PHONE PHONE <br /> ( - 2,�q-B 31)-3 n applPcable township.from <br /> E-MAILADDRESS -r" <br /> E-MAILADDRESS <br /> U.�ndu-i 2 e,p<eauk b.,itt 1491saltrhivtsh t a Q`Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi.usl) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: .12 Elevation of property <br /> NI PARCEL - 1 i-cnio- 0 C. Z O,o c frontage drams to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: (.._Q.ttt C}44.A <br /> 3\ue:.. MOOACt.5 t 2) IA: +/h: ❑Driveway permits <br /> ADDRESS: — (st te,cou,nfy,town) <br /> D521 S'f �. 1 Z µT.t4a,e.i2 A i S3512- f. <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 13959 / (puJtllc,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROW-D CRIPTION: '. <br /> 0 <br /> 0- Pi�emtgL Ve S I Of 1_L�tO '', - I� t .mr�� ❑ oning District <br /> This project is a new building or structure. ^", 1� �' ' <br /> ❑` 'ermitted Use <br /> This project is an addition/alteration to an existing building or structure ►'ASS <br /> SANITARY SERVICE: '�PERMIT NUMBER: ) ❑ RuralAddres5 r/'- <br /> EWER DEPTIC f!� 0'4 ,,,!,1.' (new/existing) ,,. <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including base ""' ' <br /> P)64- kJj4 ❑ Wetland/FJoodplain/ <br /> I_._ Shoreland (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: t `— ❑ ErOSIOnCOntrQl Permit <br /> 1 A j, TOTAL SQUARE FOOTAGE: j (slopes,disxtlrbance, <br /> filling/access)Sc �1- \ <br /> 2ND FLOOR: 1 A 3RD FLOOR: v I k ( w fi j. <br /> 1� ^, <br /> ;[°w, t J <br /> ESTIMATED CONSTRUCTION COST: ❑ Review Location Survey <br /> (Please round to nearest dollar) ♦ 'r ♦ ♦ -♦ and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes to ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes a. ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es lalo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es ❑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 o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -► -s• -► <br />