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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App It <br /> •ROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Jules Be cu i-- n X)y le :Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 7(-/Z Trcirrifit.o U a'y .ki HR 1QClI&)V1 14 Y 5371 `7 Variance(# ) <br /> HOME PHONE CELL PHONE E- 'ILADDR--S <br /> /a.) - , ' ,C 9-6/ I I ,. C)/II . , a /a '2 'te Plan drawn to scale <br /> AGENT INFORMATION j CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> jisb n 46t AwI I► \a niho r .S •HHOmes, L LC to Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 7702 Pa jvoxy-TisI / 7702 ?a.-ytte,ryTiaiI <br /> (Cit) (City, te, i ) 0-Setbacks <br /> ill 1t 011 V) W L S?)56 2_ V1/ f o1?ip n 1 53 5(p 2 <br /> 'HONE d ❑Site Plan approval from <br /> (k,c1 22-0-(_y; + 1 QD \ Z2 ( 33 I applicable township. <br /> MAIL ADDRESS l�J1I -MAIL ADDRESS ,1 Floor plans to scale <br /> i_ �.. ' I Sbn i�Kl 1►.//, I A . .i .b I Ja On inb • ..* L. •u <br /> PROPERTY/LOCATION INFORMATION (httpJ/accessdaee.co.dane.wi.us/) 'Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAG�2_ frontage drawn to scale. <br /> ❑NUMBER •i 0-7- - 0. .,N' /T - ► • - // <br /> TOWNSHIP: SECTION: <br /> `. /; SJ'✓ 141/4: NW nV @Wa y permits <br /> (state,county,town) <br /> 2 ‹roADD=ESS:0 r V e(,t)RC B Sanitary permits <br /> CSM: LOT SUBDIVISION BECOVLOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT : <br /> DE CRIPTION <br /> Si/y e. Fes; J y�ameo Li Zoning District <br /> . Ohis project is a new building or structure. ❑ Permitted Lite? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> 0/EWER ' E <br /> p�.� PT{C • B-20/7-6669_3 (new/existing) <br /> HEIGHT IN FEET � NUMBER OF STORIES: (Not including basement)•z‘ / _ ❑ Wetland/Floodplain/ <br /> O Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: , FLOOR: <br /> 1 3 7 Q j TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> ✓ / filling/access) <br /> 2ND FLOOR: 3RD FLOOR: _ / <br /> 3 7k '0 ❑ Review t_ocation Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ 1 j-/ and available options. <br /> (Please round to nearest dollar) `/,50,000. �*- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes to DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? :Yes ro4 lo [ 'Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ,Wes I o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes "o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) <br /> (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Dyes 2 o DDon't know <br /> 7. Is this to correct a violation? :Yes ■42 o <br /> APPLICATION,MUST BE SIGNED <br /> (Continue on Sack) -4, -I,. -0.545.1'12(4l08) <br />