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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> k""-' <br /> T � <br /> \if'1 S []-Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,Stale,Zip) Deed Restriction;CSM <br /> 1 003 (., �.c,...4-Y u,,a), Y Zk,,,,.a is.. ( L.wZ S 3 S"4 o variance(# ) <br /> HOME PHONE 1 CELL PHONE E-MAIL ADDRESS <br /> 1:0&-10')-1011,4, 1 1,08 -101-41(.1,, +L c,S at, } c,...4.., .1• A(+ 08ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME j/ c v P CONTRACTOR NAME ------yU <br /> o ∎.i U j .1 s ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS 1/septic <br /> I vo!h Vt... S' - <br /> (�Cit�yy.State,Zip) (City,State,Zip) Setbacks <br /> 1y1wZC'�c..v.,t- .1....)-Y-- -___ ___i <br /> PHONE PHONE ❑Site n a oval from <br /> tcg—Zr✓'1-4,1 toip appli ship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> .4-4. s tb c 4 L-.3-,N, 4-k t •A c it- [aElobr"plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evation of <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: property <br /> perty <br /> 1:1=A 639101)&2 Di-71:S5.-I Q I p i ll j frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> .M.6-zit vM-c-v.i k. 1/a: '/a'/a: ❑Drivemits <br /> ADDRESS: (scat ty,town) <br /> I e°g1. tC,::"I y ,..‘ Y []San'k. ■ •.rmits <br /> CSM: LO SUBDIVISION BLOCK/LOT <br /> 3'171 e52:3/82.4 2.3) 2.. (pu• "c, • •vate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: !' <br /> Ax, It C 3'i .41- . .a-. 0- %s4:;..\ 61/44r-45 Ili/Zoning District <br /> . []This project is a new building or structure. <br /> al Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. /-SANITARY SERVICE: PERMIT NUMBER [iural A S <br /> J v JEPTIC (new/ xisting <br /> HEIGHT IN FEET: _ —---- - __ NUMBER OF STORIES: (Nat inducting basement) <br /> 1).r 10 31 (,A /<5 I ❑ tland/Floodplain/ <br /> `-- <br /> AREA TO NEAREST SQUARE FOOT: Shot attachment) Q <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) -- <br /> BASEMENT 1ST FLOOR: q <br /> ❑ Erosio ontr• permit <br /> __ 7 c—"-1 _ (•}- 4,TOTAL SQUARE FOOTAGE: 4, (slopes, .1‘: ,: / <br /> —� �� 1 '.. - j.r��j <br /> 2ND FLOOR: 3RD FLOOR: q 1 <br /> /• -- ICI Review Locatio • ey ;,. <br /> ESTIMATED CONSTRUCTION COST: -�► i i C t and available option <br /> (Please round to nearest dollar) 30 °' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? E Yes ao ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes o [on't know <br /> 3. Have you talked with the township about your project and are they in agreement? fc YesJo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? []Yes talo <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 alNo [on't know <br /> 7. Is this to correct a violation? Des to <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ -i —► <br /> 545-112(4108) <br />