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_ltV ea ,7 i====rn <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 6erev E L EROY ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 3“,'Y 1. )C'1--c..011(i 6- D'E JE (kEoN44 uI 1 53593 variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS i <br /> ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> DA GLS3 62-1 ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS BLVD of well/septic <br /> z$ 1 Uliq &e6(4&-le r El(City,State,Zip) (City,State,Zip Setbacks <br /> DP—L—COdJ LIJ 16 S7,3 <br /> PHONE PHONE i ❑Site Plan approval from <br /> 7- Cs S-$!b$ applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 3-11 K i(*Loki @ .(vlQa I,ea,,❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL (_ A _ ( g 13 frontage drawn to scale. <br /> NUMBER ``�E'' <br /> TOWNSHIP: SECTION: <br /> 1/4: 1/41/4: ❑ Driveway permits <br /> ADDRESS: t (state,county,town) <br /> 366 g 606/cC,e4C Da\J E V 1. A , LJ` ,53593 ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 9 C v y ocop �/ (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 4WD D 1/4.5& r( D! cx_ <br /> ❑ Zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> IN This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEWER ,PTIC (new/existing) <br /> HEIGHT IN FEET: l D ( t NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1 ST FLOOR: ❑ EroslonControl permit <br /> L/O ,, TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: / filling/access)(© ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: /D!�� and available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies Lao ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ONo ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? laes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ]Yes ❑No <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) Efres MNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes INI(Vo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ -► -i <br /> 545-112(4/08) <br />