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"t1-S ,:/---,;' F- TLi �..er. <br /> , 7 6 ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ) <br /> ,A.)>\\dvJ -'EW t-1 Dnnlcr.:1/t,3O.4) Ctr,vtsj(eAsV%.e-a [r cloning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) t3•� Deed Restriction;CSM <br /> IP 0, 60x "5 1l N Jok. CivA ( ciS 19 2 Stork. 1 A Variance(# z ) <br /> HOME PHONE CELL PHONE E-MA L 4IC1,(►; <br /> E'SGvt 4, w,l■ rt-X11: .'-o LA Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> E{tL �z."-& t{ .4 14 2A N.•rc.a [}Site Plan including location <br /> AGENT ADDRESS CO OR ADDRESS of well/septic <br /> 9. 0. %o < 511 <br /> (City,Sate,Zip) (City,State,Zip) dSetbadks Gcl i icy oh Nk <br /> '1 hi& C,-41 cA (117,1 <br /> �. 13 PHONE PHONE ❑Site Plan approval from <br /> ( 10) V i 3._ un-,0 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Er3f41*c, r>a. w4)vd 6 o,. ,can Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CIRRENTZONMIG: Tel- GE: Elevation of property <br /> ❑prat, b 512-24,A Is D'A D-0 C,, frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> A\\:1;Iv.. 2 . 4: 5t__ WA: Si_ ❑Driveway permits N/j, <br /> ADDRESS: (state,county,town) <br /> \1 D \A-144 5I V INA 4 t 4 r-1-an \A�1 5'5 31 [anitary permits <br /> CSM: LOT SUBDMSIOR BLOCKILOT (public,private) <br /> PROPOSED PROJECT INFORMATION TI-4;STARF REVIEWi, <br /> PROJECT DESCRIPTION: <br /> 1arw 1.4)a h-11 J om+d 40.4 Act Aatl -;r,./N ui/v Dt ricG 1r+fi <br /> Zoning <br /> . <br /> . ❑This project is a new building or structure. ( Permitted Use? yOS y` <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: il,Rural ••reO yt,. <br /> EWER JEPTIC <br /> (n@W/ a=r0 `; <br /> HEIGHT IN FEET: ` NUMBER OF STORIES: (Not Including basement) `I <br /> Z� Ono-. ❑ Wetlapd/FloodplainI <br /> AREA TO NEAREST SQUARE FOOT. Shoreland (attach <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 0 ' ='- , •`"�'°, , <br /> BASEMENT 1ST FLOOR: ❑ E��ti OnCOM U" • <br /> k� 15 k + TOTAL SQUARE FOOTAGE: + (slopes tidisturbsnce,•i'.• <br /> 2ND FLOOR: 3RD FLOO MO'ging/access) ` -1.: <br /> (.,14ii1K.�f• 5 <br /> .tea VI;,L,,; ❑ Review Location survey <br /> ESTIMATED CONSTRUCTION COST: Q � �� • and available options. jlip <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ -0 ♦ �P <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes p ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes [Vlo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank' one) <br /> 6. Is a location survey required? (see reverse) ❑Yes o ❑Don't know <br /> 7. Is this to correct a violation? :Yes ake <br /> r• 00 ok-Oer- APPLICATION MUST BE SIGNED <br /> { �� 2. 1,�� (Continue on Back) -► -► -► <br /> 545-112(4ro8) <br />