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SUPPLEMENT#o;1Neb App;#': <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY•OWNER,INFORMATION;. `2 r a 1 ,_. CUSTOMER TO PROVIDE <br /> OWNER NAME L <br /> biNVt0 Sr���hDacY, ICE. mI1'1 SlMahbAGv- VI Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> I'IL 1 1& -10‘,1 t( 1-Qt-12-Q W T 53 53 i Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> •',, Cr • r 0 Site Plan drawn to scale <br /> AGENT INFORMATION - "CONTRACTOR INFORMATION.'„' , t _`, and includes dimensions <br /> ' AGENT CONTRACTOR NAME - <br /> r L AL) .Q.. \ .2 131 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> L1)63 15L,S3 R.- R <br /> (City,State,Zip) (City,State,Zip) ryl Setbacks <br /> Cifr Ale Cs.rciik. S-351:1 <br /> PHONE PHONE © Site Plan approval from <br /> D <br /> LP- 9& - applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> eoy, M `i Q Ty',4;1 .c,w., n Floor plans to scale <br /> ;PROPERTY/LOCATION'INFORMA TION (http://accessdane cO:da ne Wi usC; Y,_ ; r-- Elevation of property <br /> PARENT PARCEL NUMBER: CURREN ONING: ACREAGE. . LL <br /> PARCEL frontage drawn to scale. <br /> NUMBER 06 r z j8 z86�o o �-�-_� 2. !z.ca , <br /> TOWNSHIP: SECTI <br /> Pg /4. /,/4: E Driveway permits <br /> ADDRESS: (state,county,town) <br /> I 5-d t- b r t , Y []Sanitary permits <br /> CSM: LOT �� S MSION BLOCK/LOT <br /> �� • (public,private) <br /> PROPOSED PROJECT INFORMATION ,.-_ - STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> A WI 1 ul w Zoning District l <br /> This project is a new building or structure. -R ` <br /> -_E Peemitted Use? , , <br /> ❑This project is an addition/alteration to an existing building or structure. - e °'°¢F f <br /> SANITARY SERVICE: PERMIT NUMBER: ..:121 RUral Address i4.' <br /> EWER EPTIC ' ^ -o _ t) a (new/existing s: <br /> max .._ - <br /> HEIGHT IN FEET: t NUMBER OF STORIES: (Not including basement) , <br /> �,Q Z 2 ( I '❑ Wetland/Floodplam/ ▪ -- <br /> r t <br /> F• Shoreland(a-ttachment) ,i <br /> AREA TO NEAREST SQUARE FOOT: r � <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ®3 f▪ _ <br /> BASEMENT: 1ST FLOOR: ErosionCo of p'mit <br /> 1 TOTAL SQUARE FOOTAGE: ,, • slopes,disturbance <br /> 2ND FLOOR 3RD FLOOR•��O c?jfll 1'J.iaC e Sa x.e <br /> F� ReviewlL}oeatibn SUrvey <br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ♦ ♦ ♦ ♦ ;,1 and available optiohs� <br /> (Please round to nearest dollar) $ ,f i <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [' Yes LJNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Lres giNo JJDon'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? - ['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) QYes 12No QDon't know <br /> 7. Is this to correct a violation? QYes EiNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4)08) <br />