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'ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> P, r..-1 MC-so "le. ((Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) / Deed Restriction;CSM <br /> PO `Job -7 15to, Nte../A.:sc,,, W= 53707 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> o' 2141-l' Oki Nr-c. - eLo;c e-o ,.,-e.: I . C�� 0!+ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> v r`\ Me. Onry L ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS / of well/septic <br /> X /10 VI° <br /> (City,State,Zip) (City,State,Zip) Setbacks (! <br /> r-....kso., WT 5 3-701 <br /> PHONE PHONE Site Plan approval from , A__ <br /> lvo8 _ z,.. _ IOW, applicable township. N <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> rvrb-I 0 C.�e; .h�a .cv. Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT P i LONUMBE3-6� o I CURRENT ZONING: ACREAGE: ` Elevation of property <br /> 0 PARCEL <br /> az_ frontage drawn to scale. <br /> NUMBER al' Co,.-.-rent.:,.i -1 .5 <br /> TOWNSHIP: SECTION: WA r 1<C 2 U ' : O� ��4 : I O Driveway permits <br /> ADDRESS: ` (state,county, <br /> 535' ) �c:..c.� l�o�dt I`'l�c� sr,. L1� 53`7 $ yf Sanitary p- .., <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public • - /,/ <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: a� <br /> A a A .4-;0^ 4o S > , <br /> ❑This project is a new building or structure. ! <br /> • del i ited t)1 <br /> ®This project is an addition/alteration to an existing building or structure. -4e-t- <br /> SANITARY SERVICE: PERMIT NUMBER: RiratAdd <br /> ❑SEWER A SEPTIC We.l I ti I") 1-1 114 '(new! + ' <br /> HEIGHT IN FEET: I NUMBER OF STORIES: (Not including basement) <br /> I LP I *Veda ndinOodplalnt . . <br /> AREA TO NEAREST SQUARE FOOT: Shorelantl attactimenty <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) t <br /> BASEMENT: 1ST FLOOR: ErOS1orlCOntrot perrnit 1 <br /> Z,309 �y j TOTAL.SQUARE FOOTAGE: j (slopes,disturbance, . p� <br /> 2ND FLOOR: 3RD FLOOR: '© 1 / <br /> 2 4 3c)(-4 Review t_oc tl4ltll Sutuey , <br /> ESTIMATED CONSTRUCTION COST -�► Q; and available options <br /> (Please round to nearest dollar) $ L0 5 000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 24 No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ®No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 81Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 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) ❑Yes EgNo ❑Don't know <br /> 7. Is this to correct a violation? CI Yes tallo <br /> 1' I t <br /> L./ Z / Y � 2- APPLICATION MUST BE SIGNED <br /> ttzCtioe� (Continue on Back) -► •-• -► <br /> 3,3UOo <br />