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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C STOMER TO PROVIDE <br /> OWNER NAME (� / <br /> -5U()at& !1" 41 e `7 zj Zo .ng Status; CUP; <br /> OWNER ADDRESS (Number,,Street,C ,State,Zip) l ed Restriction; CSM <br /> 7( ,/ Q �S U1 LLE � ' a��14o-.I G ir fl 1 ariance(# ) <br /> HOME PHONE 'CELL PHONE E-MAIL ADDRESS <br /> (vs) I• ` (63l/ 5't-)5cv.�5‘,/ k.,-— , A , &.t. ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME P Ih t 1 <br /> PS0 a�I (LA,' Des i� -3 ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADi5"(,,RESS of well/septic <br /> (off ilcut L r„-"14' <br /> (City.State,Zip) (City.State,Zip) ❑Setbacks <br /> Mci5lIzt-ll 63-1- 5-3 53-9 <br /> PHONE PHONE ite Pla pproval from <br /> (6.5) 22,--- 96/r pplic le township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> D • ',.,4;,, C i 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLus/) <br /> PARCEL 1NUMBER: C RRE TZONING: ACREAGE: Elevation of property PARCEL❑NUMBER L�IO( " o 1� 1®1 I1' (2„ �Ytir 5 , frontage draw o scale. <br /> TOWNSHIP: SECTI N: <br /> to 1 � '/a: 1/1/; NI ❑Drivewa permits <br /> ADDRESS: ' (tie, (state, ount town) <br /> ? I o te_o■il .S t l ❑ anita , permits <br /> CSM: LOT ( SUBDIVISION BLOCK/LOT <br /> r (publ. , private) <br /> m 4 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: J <br /> ')6 30- (,f / I2 /2- 66 f r;Y-c 6-- L. Zoning District <br /> alThis project is a new building or structure. `Q Permitted e? <br /> This project is an addition Iteration to an existing building or struct e. <br /> SANITARY SERVICE: PERMIT NUMBER: (\i ❑ Rural ddr s <br /> EWER EPTIC (new/ xistiin <br /> HEIGHT IN FEET: NUM <br /> BER OF STORIES: (Not including basement) <br /> I o.vd -J1 , k i / ❑ Wetland/FI dpi ' / <br /> Shorela (att chment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached gara es above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ` ❑ ErosibnCo trol permit <br /> A�� + TOTAL SQUARE FOOTAGE: 4 (slopes, Isturbance; 1_0 <br /> �1 ��// filling/ cess) <br /> 2ND FLOOR: 3RD FLOOR: /d <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -0. -0. -+ ♦ / �� and availa options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LJr s No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? es ❑No ❑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? nYes ❑ <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blan none) <br /> 6. Is a location survey required? (see reverse) Dies o ❑Don't know <br /> ❑ <br /> 7. Is this to correct a violation? Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -. -i <br /> 545-112(4/08) <br /> ,W. IC e , ,_S 0 <br /> k , C00 <br />