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15 . ' <br /> ZONING PERMIT APPLICATION www.countyofdane.com F:=11 <br /> PROPERTY OWNER INFORMATION CUSTOMER T ROVI E <br /> OWNER NAME F �� �;, " / <br /> j 0 S ti , C - L ti I �,(aa``-e-- 54 Zoning us; CUP; / <br /> OWNER ADDRESS (Numberr,,Sltreet,Ci ,State,Zip) T� i T Deed Restriction; CSM ( C 9:�Lt <br /> 1 !t, N- U(.1 4 0'� �L cc,O(`�0� L S 3S Z/ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6A- ) . Li( I• 5-4 vi,l `P 0k I Ise f c?,./-Pf c cY':Se) 441 ZSite Plan dr n cale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes . ensions <br /> AGENT NAME CONTRACTOR NAME <br /> S 0 <br /> Site Plan 'ncl ng location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/se <br /> Cory State Zic) (City.State;Zip) 56 Se a s C 3c/fb//la <br /> PHONE PHONE :I Site Plan ••r from / <br /> applicab/71 n hip. /V — <br /> E-MAILADDRESS E-MAILADDRESS <br /> 40 Floor plans tcVaie' <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of prop <br /> PARENT PARCEL NUMBER. --��yy// /r�� CURRE ZONING: ACREAGE: / frontage draw o seal . <br /> NUMBER ITJ7IJ'J7z��175 VH - 1 / <br /> TOWNSHIP: SECTION:: r R,.6-V irk 3 1 '/: � <br /> 14 1,1%: , £,, I T�Drivew rmits <br /> (state,c unty wrr ��' <br /> ADDRESS: ( � r 5aalw,it CSM: 1 LOT f SUBDIVISION BLOCK/LOT anitas A �o <br /> L 1 (publi , private' (�J <br /> PROPOSED PROJECT INFORMATION STAFF REVI (;(�L� <br /> PROJECT,�j.S RIPTION: n _ / 7 rr I � J V�7✓/ <br /> \-€.., She(. L,t, ( 2 S C 7'1 Co v /O Al Zoning District ///��� <br /> Egffhis project is a new building or s ructure. I Permitted Use? .I)e 4S <br /> ❑This project is an addition/alteration to an existing building or structure. c ' '- <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> Ru l Address <br /> FIEWER EPTIC e_wiexisting) <br /> HEIG f IN FE L, I e NUMBER OF STORI4 S: (Not including basement) Wetland/F000dplain! / <br /> PI t`5 / ' <br /> Shoreland - - ment} <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ErosionControl permit <br /> BASEMENT. 1ST FLOOR: <br /> �0�y0 C. / '/ 4, TOTAL SQUARE FOOTAGE: 4, (slopes, disturbance, <br /> t Ilin./a - __ -..- ' r <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: $ I Z �,0 i • available •• • <br /> (Please round to nearest dollar) ♦ ♦ -► -► 1 LICE <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? JYes 'lo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes No EDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Ores QNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 0Yes al <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) Dyes No ['Don't know <br /> 7. Is this to correct a violation? Yes .j No <br /> (1 ipp APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —r —► <br /> 545-112(4i08) <br /> t <br />