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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU'TOMER TO PROVIDE <br /> OWNER NAME <br /> TA 1,1, 1AKS.rc'`3 s . Z fling Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) V D e Restriction; CSM <br /> 13 1 1414.;_Ul<,, ad .` C-a5_,riv I, W', S3 13 y ri nce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> <<`6 L ' k - +l..., c,j,fcw - 'IL a'Z - 1r,..4:II,c_ „ Si an drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION a d i cludes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Sit Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ell/septic <br /> (City,State,Zip) (City,State,Zip) o •asks <br /> PHONE PHONE ❑ t- Pla approval from <br /> .p a lic le township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PA F oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn levation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: , P P y <br /> ❑NUMBER 0 S l.�3/o)IZi o / Rce/d,,.f f,i( � • / v i S L frontage drawn • cale. <br /> TOWNSHIP: SECT� I�`�1 <br /> P)_11:0__n V W IA: N E., 1/4'A: ❑ Drivewa •ermits <br /> ADDRESS: (state ounty =' n) <br /> -LT) I c lc-,J ?z _ : v L. _ i (' ❑ :nit- permits <br /> CSM: LOT SUBDIVISION : OC4'e/ • : IC, private) <br /> I LWoO ' ►. l'SL. • t <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> C h.t_k-,.. N oning District <br /> . ❑This project is a new building or structure. MI "ermitted Use? <br /> This project's an addition/alteration to an existing building or structure. <br /> SANITARY SERVIC PERMIT NUMBER: Li Rural A• S <br /> EWEREPTIC / (new/e fisting) <br /> %41. <br /> HEIGHT IN FEET 7 NUMBER OF STtRIES: (Not including basement) <br /> ❑ Wetland/ plain/ <br /> AREA TO NEAREST SQUARE FOOT: Shorela (attach r t) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: l ❑ ErOSI011COn • permit <br /> � 4 TOTAL SQUARE FOOTAGE: 4 (slopes, • turbance, <br /> 2ND FLOOR: 3RD FLOOR: ���((f ( filling/a< ess) <br /> ❑ Revi- Location Survey <br /> ESTIMATED CONSTRUCTION COST: $ l ©O and available options. <br /> (Please round to nearest dollar) —.• —.•• -4 l <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? / es iEN NDon't know <br /> 2. Is there a wetland or floodplain on or near the property? r_i:es o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ®Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Des N <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank. none) <br /> 6. Is a location survey required? (see reverse) ❑Yes No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes [ No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► ♦ —► <br /> 545-112(4/08) <br />