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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 /> atfki f cc4R4,t 8411 UJii-P Qing Status; CUP; <br /> WNNER ADDRESS (Number, City,State,Zip) <br /> y�Q�sew'� }- 7 Deed Restriction; CSM <br /> 1Q0951' •J,94 // -I'-V ,iigi'ISw, ki 53 /// Variance(# ) <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS <br /> 7/3-—379—?Or" si4•'',e sA,e91/Ffe. b'1,9/c. . �,11 <br /> 0,81te Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> floe--sE ec,L s -!Wee 54r19r ❑Site including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of el eptic <br /> A)c�o2y ~SE- £0 <br /> (City,State,Zip) (City,State,Zip) ‘backs <br /> PBY,ve771, Air_ 53155 <br /> ONE PHONE 143-Ife: Plan approval from <br /> fob- 67&-3163 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> /Yj 7`Ml1(6714fW∎01:9 r SMO••6 oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn Ele on property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Ei <br /> 0 PARCEL fronts drawn to scale. <br /> NUMBER 04/0 OSH 4.qqr1-1 R_1 `3`I <br /> TOWNSHIP: SECTION: <br /> Ei 61,WA/ '/4: '/4'/4: Dri ay rmits <br /> ADDRESS: <br /> a (state, unty,town) <br /> icy L4Ve&S� / E ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCI�OT� <br /> W 0.46 es (p ivate) <br /> PROPOSED PROJECT INFORMATION TAF REVIEW <br /> PROJECT DESCRIPTION: <br /> PEA Oa RE v-ISg. F,& A1r ,PE,4Q 1 ,Lt S ' •oning District <br /> ❑This project is a new building or structure. ,rmitted Use? <br /> Ett his project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER LI Rural Address <br /> EWER SEPTIC Iv/ il (n <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floedplain/ <br /> ' lhoreiand' achment) <br /> AREA TO NEAREST SQUARE FOOT: Ioa� � 3 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 0p <br /> BASEMENT: 1ST FLOOR: ❑ EfOSIO Ontr permit qf( <br /> \ // 0� y�O ^a O + TOTAL SQUARE FOOTAGE: l (slopes, rbance, <br /> 7 2ND FLOOR: 3RD FLOOR,: C flIIIn Ce S) <br /> Q eview Loc ' n Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ -► ��� and available op <br /> (Please round to nearest dollar) $ p� ��IQ/Y' <br /> V �'NOr- w' DisrveMty A ee4 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ......I.... ❑Yes EKo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? 6O 2e 1 " 3 raes Eo �on't know <br /> 3. Have you talked with the township about your project and are they in agreement? .... Ies o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes t io <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) Ekes Ly to DDon't know <br /> 7. Is this to correct a violation? ❑Yes Ell< <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />