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qq. <br /> 0. t_fB, '-- 155,15 _ 4 <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ..-, L _ . <br /> `�OS� A-&ralf, .kAc\ C7 Zoning Status; CUP; r <br /> OWNER ADDRESS (Number,S`Sttrreeet,City,State,Z,ip) �Vj Deed Restriction; CSM !1 i S`f <br /> HOME PHONE 1 CELL PHONE tQ ` ILADDRESSOK )wt S��Z1 Variance(# ) <br /> ,A. 8.2- 5270' -SZO - y1/, i9 VAwe._ ,me_%+-e r o A _atx ■ ❑ Sit. Plan draws • cale, <br /> AGENT INFORMATION CONTRAC:'OR INFORMATION :, d includes d'--ensions 4� <br /> AGENT NAME CONTRACTOR NAME ..--, • i <br /> G. <br /> (❑ Si e Plan i•cluding locatio 4 <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s-'tic <br /> (City,State,Zip) (City,State,Zip) Setba41 C(?3/30 2 . /r: <br /> PHONE PHONE ite Plan pp�r rom 0 <br /> applica sip. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> Floor plans to scale V,/ <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of ro ert <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> Li 2tt j� i �f frontage drawn to scale. <br /> NUMBER 0.7 1©'_7'72 / -1L 4A - ( !.i <br /> TOWNSHIP: / SECTION: - S P., I6wLCi 3 C '/a: NL( IRA: J E Cf-Drive - permit ,IA <br /> ilV z 0._ ,2 0%.k... eocd ADDRESS: . II , own)___ <br /> CSM: Co LOT SUBDIVISION� BLOCK/LOT Sanitary . <br /> _ � <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ‘\\Li. -e Coo 0 fif Zoning Di t�/ 4 , <br /> This project is a new building or structure. CI Permitted e? / <br /> ❑This project is an addition/alteration to an existing building or structure. ,CT <br /> SANITARY SERVICE: PERMIT NUMBER: n �t�(�CI ❑ R I Address <br /> ❑S WER $SEPTIC `� LJ w new/existing) <br /> /�IN T NUMBER OF STORIES: (Not including basement) 1 <br /> �'j� 2 04 W loodplain/ ,f. <br /> J horela attachment) !T <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfi• shed area, attached garages and ab.ve grade decks or porches) <br /> Erosion 07•n • •- •. t <br /> BASEMENT: • , �� 1ST FLOOR: j� / <br /> I. Z ( 0 1v j TOTAL SQUARE FOOTAGE: j (Slop: disturbance <br /> 2ND FLOOR: 3RD FLOOR: !•r • filling/- cess) v^t.� ! .c'•1�c <br /> 551 sf 4,, % -evlew ocation Survey <br /> ESTIMATED CONSTRUCTION COST: -+ -+ $ -7 G and available options. - <br /> (Please round to nearest dollar) V l 0 2 i (:Yd ' <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? Li Yes ,lo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? AYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? CI Yes ZiNo <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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ,,allo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -0 -► <br /> 545-112(4/08) <br />