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. , <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App II <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWNER NAME.--- <br /> P nil i I // <br /> efe _. ❑ Zoning District <br /> OWNER ADDRESS cc(Number,Street,City,State,Zip) , <br /> .3889 Vw)Lodp (�- RCS v `P12C ti14 (( k'Cit ❑ Permitted Use? <br /> PHONE E-MAIL ADDRESS <br /> 6,08 S3 J 4•.� ❑ Zoning Status;CUP; <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Restriction;CSM <br /> AGENT NAME CONTRACTOR NAME <br /> —D 4 A—i i �RLve l/ ,_.mil :t'R.Rw e if QC�7Ll Variance(# ) <br /> AGENT ADDRESS CONTRACTOR ADDRESS ❑ Site Plan drawn to scale <br /> `�g�U ��2� � and includes dimensions <br /> (City,State,Zip) (City,State,Zip) // ,, ,, <br /> iVU 40 i5 nu / UJ/ 5 3 7/8 ❑ Site Plan including location <br /> PHONE PHONE <br /> 6 03 .- 2-2 2—/ 7 3 D of well/septic <br /> E-MAIL ADDRESS E-MAIL ADDRESS I <br /> ---A2 we1Irec-n Ail'` e5./we C] Setbacks <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) r ❑ Site Plan approval from <br /> PARENT PARCEL NUMBER: ZONING: J ACREAGE: applicable township. <br /> ❑ NUMBER 038-0708-/9/-6021-o A-1 ` >8 pp bletownshi <br /> TOWNSHIP: , SECTION: ( ! <br /> 1 lidLe )o10 19 '/a: NF Y4'/4: St ❑ Rural Address <br /> ADDRESS: (new/existing) <br /> 58K 5wo bd., "a s ❑ Floor plans to scale <br /> CSM: LOT SUBDIIVISION,- BLOCK/LOT <br /> OW loort ❑ Elevation of property <br /> PROPOSED PROJECT INFORMATION frontage drawn to scale. <br /> PROJECT DESCRIPTION <br /> Itil V2QMX, & tIflm1acJc/ 0ij' ❑ Driveway permits <br /> . W This 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 SERVICE: PERMIT NUMBER: <br /> CI Sanitary rivateS <br /> CI SEWER SEPTIC (public, private) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (NsUr,cluding 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) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR' (slopes,disturbance, <br /> 2ND FLOOR: tgpF[aOR �� filling/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ �� N'• �— and available options. , <br /> Please round to nearest dollar) w o�, � <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No IfJ�6on't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes Li No ligifkt know <br /> 3. Have you talked with the township about your project? CI Ud'IV <br /> Yes o w <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑Nosf K <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 ❑No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes 44 No <br /> IS\. ° APPLICATION MUST BE SIGNED <br /> n`1 (Continue on Back) -► -► <br /> 545-112(itos) �� Q t� <br /> C\9 <br />