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'ONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION <br /> CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> o`f -YYIJNbY scH(NEN� Z) �/ <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Zoning Status;CUP; <br /> '79 Is rL ,j4 t2 l t/E4 RD <br /> Deed Restriction;CSM <br /> HOME PHONE i Gig' CELL PHONE E-MAIL ADDRESS Variance(# l <br /> 29 - 1 to ( TSGKVV�ki e-6"f 1Mg- I <br /> Site <br /> AGENT INFORMATION and includes CONTRACTOR INFORMATION u drawn scale i <br /> AGENT NAME udes dime ns��� <br /> CONTRACTOR NAME = Z� <br /> g21 P+K) C1 riot.) <br /> AGENT ADDRESS ` CNuT +t`T7iU6 Segi Site Plan inclu "ng I cation <br /> CONTRACTOR ADDRESS q <br /> 906 p. F atoK- K of well/septic N <br /> ��• X06 N,f�°tt�g ��. c <br /> (City,State,Zip) (City,State,Zip) / /S�1e CkS e,C+ f� <br /> PHONE N Nki e6 Ai s--35-/7 v.)to(UN 1 IL 6 ) tovT_ S3S�'•7 I 0 -=- J <br /> PHONE ❑ Site an approval from f <br /> 6o8- 2. 5"- _IJ5i{7 60$- S�{ - °iS Z applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS a township. z0 Li LGgJ C �(( L , � Qu 1'�Lt;JC}/V e l-J>�1 ,N& Floor plah+3lt le '—�jq/ROPERTY/LOCATION INFORMATION (http://accessdaneco.dane.wi.us/) YvvY �»"�JJJ <br /> ' PARENT PARCEL NUMBER: C REN ZONI / ACREA7: 2/Elevation of propert <br /> ❑ NUMBER �S O71 lc)2 SO22 ,� <br /> q�� frontage drawn to s <br /> TOWNSHIP: S CT O ` <br /> ('Y\t b ti1£TO N '/a: +/a+�a. h/ !�( Driveway per <br /> ADDRESS: (state,coun ,town) A <br /> i -79 is- 13L-A< g-t V G2, WO <br /> csM: I LOT SUBDIVISION BLOCK/LOT Sanitary permits 5 <br /> f' A �4 IQt� Vj< Z (public,private) 0 ! <br /> I • A 1• <br /> PROJECT DESCRIPTION: STAFF REVIE <br /> I Al l 10EJ Pkbcvt0k) 3 t/ )4 27 / <br /> ivi Ate 6(z- EflR PYt Zoning District - <br /> • ❑This project is a new building or structure. '2- I 6 r <br /> rai This project is an addition/alteration to an existing building or structure. Permitted Use p <br /> SANITARY SERVICE: � I D t I <br /> PERMIT NUMBER: RUr- - v <br /> ❑SEWER SEPTIC Si 1 O S (ne 11 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) �_�— <br /> St I 'A Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachme t) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) T <br /> BASEMENT: 1ST FLOOR: <br /> X -7-7 ,� <br /> Z t 4 ErosionControl permit !' <br /> 3� ' 34-/ 4- - ' ' ,, TOTAL SQUARE FOOTAGE: ,j, (slopes,disturbance, 1 <br /> 2ND FLOOR: 3RD FLOOR: filling/access) ( ) <br /> coo r ESTIMATED CONSTRUCTION COST: /04._ <br /> Review Location Survey <br /> (Please round to nearest dollar) '0 —∎ —0. -♦ --0. -41. $ I s or)d d available options. <br /> d <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Pr, Yes i.No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? <br /> Li Yes Vg No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? tff-Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 4‘4No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# <br /> (leave blank if none) <br /> 6. Is a location survey required? (see reverse) <br /> ❑Yes I8-No LI Don't know <br /> 7. Is this to correct a violation? <br /> LI Yes 121-No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) —► .-� •.� <br />