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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAM <br /> �` �' ning Status;CUP; <br /> iOWN ER ADDRESS Number ��eel,,City,State,Zi `/^�`'�� 'L/�1�1y���\ Deed Restriction; CSM <br /> HOME PHONE � CELL HONE �\ E-MAIL ADDRESS <br /> �� 53 Variance(# ) <br /> i.A, I.+1'Zg7—�1 le& '- - JP . .∎ LA •I I Ut . CC)■LISYVV aSig Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR IFFORMA''ION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> E J,Frite Flan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE Site a royal from <br /> PHONE � O <br /> . applic township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P p rty <br /> ElPARCEL (alb /A_)- //Caq i` .r -� frontage drawn to scale. <br /> NUMBER /�--� 1 �P l.e <br /> TOWNSHIP: SECTION: <br /> • <br /> NI t-Y'`('`n.tS` 2 1/a: IV 1/1/: (e._ 111 Drivewaypermits e <br /> ADDRESS: - ", •,•Unty,town) <br /> ill 6 41 STOje CSM: LOT / SUBDIVISION BLOCK/LOT zanitary permits 3 <br /> 1 q�3 1 (public,g 'J� <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: - <br /> Nn , (ALkr-p t-YLO■ng District <br /> . [2ihis project is a new building or structure. 41.4P i itted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 44 Ural Address <br /> EWER V EPTIC 13-a 0/7 —060.5C (nev <br /> HEIGHT IN FEET: ' NUMBER OF STORIES: (Not induding basement) <br /> 1t etland/Floodplain/ <br /> attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT:0/ 0 1 ST FLOQ�2: S- <br /> rosionC• • -•-rmit <br /> `/'+1J 3 f ,+ TOTAL SQUARE FOOTAGE: j (slope , •isturbance, <br /> fill' /access <br /> 2ND FLOOR: 3RD FLOOR: I 9 O <br /> evi Location ey <br /> ESTIMATED CONSTRUCTION COST: /� an available o <br /> (Please round to nearest dollar) "� ♦ ♦ ♦ -4. -+ $ V[ o <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Olo ['Don't kno <br /> 2. Is there a wetland or floodplain on or near the property? :Yes go ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? IYes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes alo <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) :Yes Elo QDon't know <br /> 7. Is this to correct a violation? Elves llo <br /> APPLICATION MUST BE SIGNED <br /> 545-112 laiosl (Continue on Back) -4. ♦ -► <br />