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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME . rn 1 <br /> 3It""� Gn OIGnC t�Ohy ning Status;CUP; <br /> fdWNERADDRESS (Number,Street,City,State,Zi p� • Deed Restriction;CSM <br /> \�/// �$77 1q�e.0o?G ► ,C.(crs Gans , WI S5S Varia (# > <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Loa- % - LtA- a Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CO RACTO AME <br /> Ac'tts& Eck,-1'�Sl h, Z-L/-- ►ic, v< Si Plan including location <br /> AGENT ADDRESS CONTRA ADDRESS of well/septic <br /> -10O tL.yovaC Cc. AT313 <br /> (City,State,Zip) (City,State,Zip) S cks <br /> PHONE PHONE'JZ 51 <br /> PHONE ❑Site PI approval from <br /> ta- s _Seiril app' le ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> t_ •V ,IS611 41 cti A 4 .,,. 0 Flo r p ns to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: L CURRE ZONING: ACREAGE: E ation of property <br /> ❑NUMBER Inn DU-(�'Na^Q l ti-a as .W-1 rontage drawn to scale. <br /> T WNSHIP: SECTION: <br /> sec c '/a: '/a'/a: ❑Drive its <br /> ADDRESS: l 1 �+ p , (sta , nty,town) <br /> 11 TWk-'' .)cc-Zb. j Cm f lcor», W 1-.S55'D3 ❑Sa ita •-rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> L I 1 (+.+ t, private) <br /> PROPOSED PROJECT INFORMATION ST ' REVIEW <br /> PROJE T DESCRIPTION: <br /> kblintlIt. 42-Vith1hSdei.1L ct4 Lb;14 mew clekiL. n z/ DiSthCt <br /> his project is a new building or structure. P tted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: ,PERMIT NUMB : ❑ R t, , •• -''`` <br /> EWER YC EPTIC (n- sting <br /> HEIGHT IN FEET: �` NUMBE JOF ST IES: (Not including basement) <br /> aQ'► ) ❑ Wetlan• I ;••=,lain/ <br /> AREA TO NEAREST SQUARE FOOT: S.• attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) Li ,• permit <br /> BASEMENT: 1ST FLOOR: <br /> Erosion <br /> am j TOTAL SQUARE FOOTAGE: ,, (SIO+ • =' rbance, <br /> 2ND FLOOR: 3RD FLOOR: �� fill '•lSCCess <br /> ❑ Review .+ ,'•n Survey <br /> ESTIMATED lease round CONSTRUCTION COST: --► ♦ ♦ ♦ ♦ $ '� and ava options. <br /> Please round to nearest dollar) --. ,. )C The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [1.11qo ['Don't kno <br /> 2. Is there a wetland or floodplain on or near the property? Elves LP"' ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes Eo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes EVo U JD <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if one) <br /> 6. Is a location survey required? (see reverse) ❑Yes to ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes I" `'S <br /> APPLICATION MUST BE SIGNED <br /> 545-112 caiosl (Continue on Back) -. -► -► <br />