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6C? ZP - 20 (7. .00 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION /' CUSTOMER TO PROVIDE <br /> OWNER NAME 1—i,�Ol [)01,A1,ngS LLc, -- <br /> ts� __ ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number;Street,City, e.Z+ Deed Restriction: CSM <br /> ,LI-71 14t1 S fl�tr� o� (.07- ,5358/ Variance(# ) <br /> HOME PHONE CELL PHONE cc1�� J E-MAIL DRESS <br /> (00 'S. Z37• I iA -\-- 4-47111:1 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR C1FOR?.IATION and includes dimensions <br /> AGENT NAME 'I CONTRACTOR NAME <br /> A0p ❑Site Plan including location <br /> AGENT ADDRESS ESS CONTRACTOR ADDRESS of well/septic <br /> {City.State,Zip) -------__— -------- <br /> {City,State,Zip} 0 Setbacks <br /> S4-011.400,\. tor 53589 <br /> PHONE --- PHONE ❑Site Plan approval from <br /> &DD- j-4001 applicable township. <br /> &N IL ADDRESS E-MAIL ADDRESS <br /> 149 ,' 5(• We r-' ❑Floor plans to scale <br /> PROPERTY/LOCAT'.ON L•NFORMATION (http://accessdane.co.dane.wi.usn ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> El <br /> PARCEL �1 `1�, ^\ frontage drawn to scale. <br /> NUMBER OSo/T0510-0 t 1'1 1011 <br /> ��ell <br /> TOWNSHIP: SECTION: <br /> KaM .•.ek. 1/4: 1/41/4: ❑Driveway permits <br /> ADDRESS: fi��/� ` <br /> Li (state,county,town) <br /> CSM: ' l OLOT 0etiNI LC SUBDIVISION BLOCK/LOT <br /> ❑Sanitary permits <br /> g194 i (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJE T DE��SS`CRIPTION: `` <br /> •M•K, Si-0 val L 1�, P. 30x150 ❑ Zoning District <br /> . This project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. U Permitted Use'? <br /> SANITARY SERVICE: PERMIT NUMBER D Rural Address <br /> EWER r)EPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement} <br /> 111 LI 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) 1 <br /> BASEMENT 1ST FLOOR: ErosionControl permit <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR 3RD FLOOR: <br /> filling/access) <br /> /J S as LI Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ) <br /> (Please round to nearest dollar) '♦ "'∎ ♦ ♦ "'0. ♦ $ g G��� 00 and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies ISNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes Frio ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? D es Dia <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? u es ❑Mo <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 Elo ['Don't know <br /> 7. Is this to correct a violation? Dies glNo <br /> APPLICATION MUST BE SIGNED <br /> C/ (Continue on Back) -♦ • —. <br /> 545-112(4/08) (� 1 /n <br />