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7C)1 0, <br /> \ )01k-li'i ..--- <br /> ZONING PERMIT APPLICATION wwiw.countyofdane.com ;SUPPLEMENT to WebApp#.' <br /> ;_ <br /> ;PROPERTT.OWNERINFORMATION �.>. , .` ' ,y OFFICE„USE..OP�ILY <br /> NER NAM .� <br /> Pr �1t�,� �E ►GNTS ' G ❑ Zoning District <br /> OWNER ADDRESS (Number;Street,City,State,Zip) <br /> _C\e � - 0 ► AD 1 ��S 8 ❑ Per'mitted Uses <br /> PH NE E-MAIL ADDRESS <br /> tpQ •— 73 - � ) 'S �— ❑ Zoning Status CUP; <br /> AGENT,.INFORMATION -'`" J� ` 'CONTRACTOR'1NFORMATION�. ri,!.;',` r�,, <br /> Deed Restnction; CSM <br /> AGENT NAME CONTRACTOR NAME Variance•--,:„,# ) <br /> AGENT ADDRESS CONTRACTOR ADDRESS ❑ Slte PIa'n drawn t0 SC3IG, <br /> aIp Kt.nQ _ `` an`d includes dimensions -' <br /> (City,State,Zi (City,State,Zip) <br /> ��� \ �� � �jp ❑ Site Plan including location <br /> PHONE PHONE Of Well/Septic <br /> E-MAILADDRESS E-MAILADDRESS ;❑ Setbacks r <br /> PROPERTY/LOCATION7NF,ORMATION `(httpel/aa essdan`e co dace wius/ ' . <br /> 1 � � ❑ Slte Plan approval from <br /> PARENT PARCEL NUMBER: ? ZONING ACREAGE: applicable township <br /> ❑ PARCEL 60-ADA-9�_ 3 �� <br /> NUMBER �A> ' l <br /> TOWNSHIP: <br /> SECTION:N: ,/4 �� 1/41/4 ] Rural Address <br /> L)V An ;.. (ne.w/existing} <br /> ADDRESS: <br /> l: <br /> C)U� U4{\2 Ln H Td�.I. I W'� 5 35�S(i ❑Floor plans to{scale r <br /> CSM: LOT c� SUBDIVIS`IO/N BLOCK/LOT a k *" f <br /> �D1 �S O `►� �! t P ❑ Elevation.;of property <br /> PROPOSED`PROJECT INFORMATION;` '''''''''''''''''''''' ''' ''''''''''4'''' ''':- .1'1.."s frontage drawn"to scale. <br /> PROJECT DESCRIPTION: x <br /> %O le D t <br /> ��( r 2c wt 5� S �i 4 $t D er K �t�1 �m P .{��Drivewa�r PermJts;° <br /> . ®.This project is a new building or structure. <br /> (stae, county town) <br /> ❑This project is an addition/alteration to an existing building or structure. y❑ Sanitary permits <br /> SANITARY SERVICE: PERMIT NUMBER: (public,p�r�vate <br /> 14 SEWER ❑SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ❑ Wetlaftd/Floodplaln/ <br /> ''7 '�0 f 0� h �A,� Shoreland {attachment)' <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) Li ErOslondorltro1 permit <br /> BASEMENT: 1ST FLOOR: (slopes dlsturba Ice, <br /> 1�! 4, TOTAL SQUARE FOOTAGE 4, <br /> c( (p filling/acgesss) fi, ' ' <br /> 2ND FLOOR: 3RD FLOOR: ,, ^^ , ", " 'i` 't <br /> tS1 <br /> —� ❑ Review Location Survey , <br /> ESTIMATED CONSTRUCTION COST: O 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? <br /> U No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? Li Yes ®No ❑Don't know <br /> 3. Have you talked with the township about your project? Yes ❑No 0 <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 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? ❑Yes No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes 4No <br /> T BE SIGNED <br /> (Continue APPLICATION on BackMUS) —► — -i <br />