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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUS ER TO PROVIDE <br /> OWNER NAME <br /> %ricw1 'tCaq Zoning Status; CUP; <br /> OWNER ADDRESS (Numtpar,Street,City,State Zip) Deed Restriction; CSM <br /> /07 IY /'`J 1{wcAf rm c,� Variance(# ) <br /> HOME PHONE ELL'HONE E-MAIL ADDRESS <br /> I.Cc.c ta.O L'°lS 6t (C vi .1_ •✓ 2 • ' -Ccro. e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site n including location <br /> AGENT ADDRE CONTRACTOR ADDRE' well/septi <br /> (City,State,Zip) (City,State,Zip) S a <br /> PHONE PHONE ' Plan approval from �7 <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> lour plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> �( PARENT PARCEL UMBER. CURRENT ZONING: ACREAGE: P P y <br /> '- NUMBER 659�o80b-0$3-9710 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> !'Na20Actw;e '/4: '/4'/4: ❑ Drivew o tr town) <br /> ADDRESS: <br /> 101 i'$ ) EL s„1\ Pa- Sanitary permits No C <br /> CSM: LOT SUBDIVISION BLOCK/LOT `�,, <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION TAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> RI lacr OIci (1xi-s ch tinw.Q to(L11 4914.) 3d,x5-0 b..2,4 Zorylng District <br /> . <br /> This project is a new building or structure. L!-. ermitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT 7: ❑ Rural Address <br /> ETEWER REPTIC Iv (ne - • <br /> HEIGHT IN FEET: NUMBS OF STORIES: (Not including basement) <br /> R I4_ ❑ Wetland/Floodplain/ <br /> �7 �� <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shorelan• attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) C' <br /> BASEMENT: 1ST FLOOR: ❑ ErosionC•• • •ermlt qt� <br /> + TOTAL SQUARE FOOTAGE: ,l (slope disturbance, 0")�����Vl <br /> I �` G� filli cress <br /> 2ND FLOOR: 3RD FLOOR: /+ <br /> i <br /> tC <br /> e ()C- Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available optio <br /> (Please round to nearest dollar) <br /> 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? yes ❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ENo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Ries ❑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) ❑Yes No ['Don't know <br /> 7. Is this to correct a violation? Lives ao <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -► ■ -► <br />