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ZONING PERMIT APPLICATION www.countyofdane.com PI" .= <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNE N,A.ME ���� ��,� � I- I- <br /> L11 t Qr' V.n h i�e.S ) 1_6 ❑ Zoning Status;CUP; <br /> O'SINERADDRESS ( tuber,Street.City.State,Zip) <br /> Deed Restriction;CSM <br /> to .rrl., 4I ll pr. _ 0 re vr, O S357 5 Variance(# -) <br /> HOME PHONE ;CELL PHONE MAIL A RES , <br /> (cD?-$3 $t,e1 - COVertu) .,nefi U Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT AME CONTRACTOR NAME <br /> r. <br /> IT 1tri t- � 5 e(f ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> City,State,Zip) (City,State,zip) ❑ Setbacks <br /> 0 rea Nn_ L 53 -7. <br /> PHONE PHONE ❑ Site Plan approval from <br /> (ij og- 8'3 —8'l, applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> - bp f$Z le r-1 -011, rie-r ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLusl) �] Elevation of property <br /> PARENT P4 gLNUMBER: CURB NT ZONING: ACREAGE: <br /> ❑ PARCEL vo!A 3(.9 I,;y.;S 7 R_3 frontage drawn to scale. <br /> NUMBER L�,Si a �/. 3�y <br /> TOWNSHIP: �R SECTION: <br /> 1,0N_ N -- CI Driveway 1nu: 1 4 / bit`'- 1/4:___ - !! (state, ty,town) <br /> ADDRESS: / <br /> 1 t j 0/261 ce COLIC 1 W 53��(` ❑ Sanitary permits <br /> CSM. LOT SUB ISION I Si nrtta nT <br /> 351 1p a 9! l i i Cl (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: �i L <br /> � <br /> • <br /> � .trs- '}- 1ar th .Ar ,✓2.1 rt idrgb(,°f clef t( .jof bacl'( ❑ Zoning District <br /> . ❑This project is a new kuilding or structure. <br /> ,�,( ❑ Permitted Use? <br /> t�SiThis project is an addition/alteration to an existing building or structure. <br /> I--: — —— — — --- — — — — —, ❑ Rural Address <br /> SANITARY SERVI ct PERMIT NUMBER. <br /> SEWER J SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> j ❑ Wetland/Floodplain/ <br /> � - - ----- 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 - -- ❑ ErosionControl permit <br /> I b V p� j TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: (j filling/access) <br /> -_�- I a 0 0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: $ / —� and available options. <br /> (Please round to nearest dollar) ♦ ♦ "� ♦ ♦ •"♦ $ ` M) <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 IiiNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ,54Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes J 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) RECEIVED-- UYes -iiefNo D.Don't know <br /> 7. Is this to correct a violation? ❑Yes •"No <br /> JUL 1 U nN° APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► ♦ -► <br /> 545-112(4 1681 <br /> DANE COUNTY PLANNING&DEVELOPMENT <br />