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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C STOMER TO PROVIDE <br /> OWNER NAME .1 <br /> C)1 U I 0 QL Pu7o nfil FR O(R)CrSn1Y !_ honing Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) a Deed Restriction;CSM <br /> t1,.eS ry)ct [IICt�/ E-MAIL l�I1Vi2(FTo� ll L 53 Variance(# ) <br /> HOME PH NE CELL PHONE I ADDRESS 1 , <br /> C/O? t.3 ` -3 /i bl J, - # CA_)M I E bOr125. /Yet DI ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> N (4 0 10 71)F ( ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> S /9-n)r <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE ❑ It- -la, :pproval from <br /> • ' ' -ble township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> F •or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ,,-- <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: - levation of pro <br /> ❑ <br /> N PARCEL UMBER 470�j- 06/ - 5939 i (- is? : frontage dra to scale. <br /> TOWNSHIP: SECTION: <br /> /19)OD1,E !D '/4: 5 i) 1/4'/4: /V F ❑Drivew permits <br /> TO (s ,coun awn) <br /> ADDRESS: <br /> J A r I 0)DV1_E-2 p/11 U .ani permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (•U• IC,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> En GI(SE Enl g f ifth PO r c- ex161-m5 blue A. • zoning District <br /> . ['This project is a new building or structure. V/ i Perm . <br /> jaThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural ' •• --s <br /> EWER nEPTIC (new/e isting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> /P/_z// r ❑ Wetla oodplain/ <br /> Sho AREA TO NEAREST SQUARE FOOT: (attach ) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ Erosion L, ' • permit <br /> / j TOTAL SQUARE FOOTAGE: j (S ••- •.sturbance, <br /> 2ND FLOOR: 3RD FLOOR: /7 fills : access) <br /> 6' ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION options.♦ ♦ (1 , / G�'O and available optio . <br /> (Please round to nearest dollar) �p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ao ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ao ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes ao <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes EVo <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 'lo ['Don't know <br /> 7. Is this to correct a violation? Eyes RiNo <br /> t APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> �\ (Continue on Back) -ta -+ -►' CC ',,+` <br />