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Dew, 6p 5 7(o --x,37 0 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN R NAME e- i 1 ,, <br /> ra� J G""`5a� oning Status;CUP; <br /> WNERADDRESS (Number,St t, ty, te,Zip) p /�/� �/ 5?)7 L' Deed Restriction; CSM <br /> a �� �� ' -�- 0' �'�(/`(S Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 0 bC2-41 Lt . '' 8 S' t i 14'30 MI Sa)J e_1:21-0023620. «tt^ Kj),SitgPlan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> VJ t i i�`� ik gm Sit P including location <br /> AG NT ADDRESS CONTRALTO ADDRESS of eptic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> ( M5t.v� L <br /> S- <br /> etbacks <br /> PHONE PHONE 0 Site a pproval from <br /> LP U$ —5/C — rr 7 2° S 7 appl. a township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> wr i 14,4 lot,e<elaic a. e 5 e1- ( . loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) eVation of property <br /> PARENT PARCEL NUMBER: CURRENTZONING:7 t* r0 <br /> ACREAGE: y <br /> NUMBER oo5/b-?10 •-O,SI - -3 <br /> p p <br /> ;2-4 (1j frontage drawn to scale. <br /> TOWNSHIP: L{S 07 SECTI <br /> Bi ba ru,n 6t'Oc..4.� '/4: '/4'/4: 0 Driv a emits <br /> �/ ADDRESS: S (stat ounty,town) <br /> t1 1 ip c31 J D Sa ' - •ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 347- 3‘.(I3V 6kKft2 (o0ac6L-,/ (publ.' •rivate) <br /> PROPOSED PROJECT INFORMATION <br /> ding <br /> TAFF REVIEW <br /> PROJECT DESCRIPTION: 1 I n <br /> District <br /> DThis project is a new building or structure.. emitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: f ❑ Rural Address <br /> MS/EWER FIEPTIC IV/ (new/ ' <br /> HEIGHT IN FEET: NUMBER OF STORI (Not including basement) <br /> ❑ et oodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoe attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR:�� ❑ (slo •nC• trot permit <br /> ("� ,` TOTAL SQUARE FOOTAGE: j (slope- •isturbance, <br /> 2ND FLOOR: 3RD FLOOR: \J flllln• acc- s) <br /> SO S� <br /> Revie o 'on Survey <br /> ESTI D CONSTRUCTION COST: OV <br /> and )4oPfions.options. <br /> (P se round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ 3(�C� <br /> `5J <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies "No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes ( o DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes DNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes Flo <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) Dyes 36o ['Don't know <br /> 7. Is this to correct a violation? Dyes gIC <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► <br /> 545-112(4/08) <br />