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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App IS <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> -1(.'t0 A Da\/.12_ Vk)r2LS0,--a( S Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> N\' fl \ �c>>✓4-_e_ Vck C.31 5, Vv t S Cl2_� Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> C12 24t.o'23 '4 2W--e-∎S(1Ctilgh.0 i.■ .Co`. Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 1.1.C.- <br /> E11Cpt A.co_s (y 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 03c o 4 i,A hr- <br /> (City,State,Zip) (City,St1ate,Zip) MI Setbacks <br /> 0l si ll•t- k5 ,W( `53c12_'-5 <br /> PHONE PHONE �< ite Plan approval from <br /> 0 . 7-20 • 0=i v to a plicable township. <br /> �� 0...oar-t.) <br /> G\ce� <br /> E-MAIL ADDRESS E-MAIL ADDRESS/� plans to scale <br /> Ql ACS o:N e,P.�ccm -coask ,cc-E argor. <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> ['PARCEL frontage drawn to scale. <br /> NUMBER 01010°1 12.1 12z_-Zog)--0 A-12-t7--) 1 •2.G'3 <br /> TOWNSHIP: SECTION: 1 . <br /> `COOL 11. 9_11 1/a: FyE 1/4'/4: tW Drivew yper s <br /> ADDRESS: �j (12-8-- (state,c u ,town) <br /> 19 `-' � c ( [`San∎ ry rmits <br /> CSM: C1f�! f� LOT fiSUBDIVISION BLOCK/LOT . r , <br /> .__- (publi private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> �PS(Ai.EC\kA\ S-1rl,LC--k-1._Ce I -e. ❑ Zoning District <br /> This project is a new building or structure. <br /> Cl <br /> Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ R .ral Address <br /> EWER IEPTIC i'3-2o1i-' (00 - ) 49 /existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 235 ( • etlan• I •i plain! <br /> ',{� 1 C( -O ' Shorel., . :.� achment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionCo trop I <br /> Z ✓ i,.r + TOTAL SQUARE FOOTAGE: $, SIO dirt • <br /> �-, �3� �+ ���j�l fi Ing/:c, - <br /> ❑ Review Lo ati.n ry y <br /> ESTIMATED CONSTRUCTION CO-0T ii:D4" 0-0-1S1 c-+'- and avail.'∎ e • o s. <br /> (Please round to nearest dollar) ♦ .-1. --0. 3 , co <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or rake? ['Yes [z]No [1:Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes nNo ElDon'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# t LO 23 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ['Yes o ['Don't know <br /> 7. Is this to correct a violation? [-_-_]Yes No <br /> C <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) • ■ -+ <br /> 545-112(4/08) <br /> 1 <br />