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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 /> T RA y t 4 K(Zl' T A ANIElZ_S0NI ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 044q COURSE VIEW D(?i\JE pLI S(\t T S�'KINGS Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL AD?RESS <br /> 73— 4 S , 1 S-75 - 4-/5 3 I ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 0LSO N WILLS L-It\II VAPII\ic 0 LSO S1 'fl IBS l AN,pSCAPI\\1C4 ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> `-- C I-tkki kA -T? ' cli.A L/ 3$7 Sc K N,2T e- I-O A <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> in.tUCE iu WI 5TS(e_z NA∎V)L 01 \ 535 (D2 <br /> PHONE PHONE ❑ Site Plan approval from <br /> l0C1s- —'2-1 —9(4° / (00$- FS 2-i- — C1'40 I applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> -}e ' OMO."1 'U t I\S 0 CC-04 cL0 % ISo 11\5.CO W► ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: 2_1 ACREAGE: Li Elevation of property <br /> ❑ PARCEL v frontage drawn to scale. <br /> NUMBER R�51 VE-11AL ZS I g -1 Z <br /> TOWNSHIP: SECTION: <br /> P LE AS A K1 I S h -1 Iv CI '/a: '/a'/a: ❑ Driveway permits <br /> ADDRESS: n �,` \ (state,county,town) <br /> CSM: -- 4`I Cc�Ogs& J 1 0�2_, VIVI EAcAIVTSOCWLOlq(A S ❑ Sanitary permits <br /> (public,private) <br /> I O COUNn-Y6--uk56-tip <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> I NCIe-OV ND l>001-- ) 12-42-0 0 1 11 MI r t-lc-1 r ❑ Zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> 'I,lAThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER ❑SEPTIC (new/eXiSting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) <br /> ❑ Wetland/Floodplaint <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ""∎ --∎ ♦ -Ir. -10. $ 1 Q0 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes n o ❑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? L'Yes LI No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 4■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 %t to ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes litNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► <br /> 545-112(aroa) <br />