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zPA Ito <br /> - ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App 0 <br /> PROPERTY OWNER INFORMATION OF ICE USE ONLY <br /> • OWNER NAME PI ti-Ty Ai R Q E <br /> / Z Ing District <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ^ <br /> 20 /13 Op huff Ao t e «0e/ P itted Use? <br /> PHONE E-MAIL ADDRESS <br /> 608 3g7-,51126 <br /> .. Zoning Status;CUP; <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Restriction;CSM <br /> AGENSAME .-^ COWSZACTOR NAME Variance # <br /> Gllan �-e 'k>e. if t-1l 2 We// Pcv L s Variance(# <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> SfP AS �'pti,fA i9-c-ee- _� Se/8 iuty Site Plan drawn to scale <br /> an includes dimensions <br /> (City,State,Zip) <br /> (City,State,Zip) <br /> I " '0101,SUN ( (A3 S S3 7 e Site Plan including location <br /> PHONE PHONE <br /> 6664 .2 22 - l 736 of well/septic <br /> E-MAIL ADDRESS E-MAIL ADDRESS / �/ <br /> –F►�2 w 0 /Tec4C'h hey. Ne l' u Setbacks <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Site Plan approval from <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: <br /> ❑ PARCEL 018/07//�,� _Q�� _D RR— / applicable township. <br /> NUMBER 4. <br /> TOWNSHIP: SECTI ON: <br /> 5-5 ei6;'QaI)e /l/ '/o: /VLU '/a'/: Skj ❑ Rural Address <br /> 00 ADDRESS: new/ !) <br /> 20 re Up h or, i c)AcQ <br /> Of <br /> CSM: / LOT SUBDIVISION BLOCK/LOT Floor plans to scale <br /> /0643 <br /> . Elevation of property <br /> PROPOSED PROJECT INFORMATION frontage drawn to scale. <br /> PROJECTDESCRIPTION:. <br /> 13gao et tot/f/ Pct)L—'- ❑ riveway permits <br /> . j4This project is a new building or structure. (state,county,town) <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> Sanitary •- •• _ <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> J SEWER SEPTIC (publi ,private) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ❑ 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) rosionControl permit <br /> BASEMENT: 1ST FLOOR: O <br /> TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> fill g/ cess) <br /> 2ND FLOOR: 3RD FLOOR: <br /> eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ /� ��) c� and available options. <br /> (Please round to nearest dollar) i C./ft/ <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. There is a wetland or floodplain on or near the property? xi Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project? ❑Yes iii No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No e <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 g[No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes allo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(1108) <br />