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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> (A)i l l la igy2 <br /> [ being Status; CUP; <br /> /OWNER ADDRESS (Number,Street(City,State,Zip) Deed Restriction; CSM <br /> W 7o/ al 0i. J,u.J , - .m-)l l2; -z--/ (11---) 3 5393 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> c ,,,ys3(I.,qo7 (QO -7/2. ?VA P`} Ewt/l;g3,\ D 0,30),A Deem.. <br /> - e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site ' eluding location <br /> AGENT ADDRES� CONTRACTOR,ADDRESS of w ptic <br /> (City,State,Zip) (City,State,Zip) Eietgacks <br /> PHONE PHONE [_Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ❑floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) n Fl�lation of property <br /> PARENT PARCEL NUMBER: CUR ENT ONING: AC EA"GEE: '.. ' P p y <br /> ❑NUMBER 091). 33-15-00- /`e / rontage drawn to scale. <br /> TOWNSH1P::�{j 14 SECTIION: ,,. t; `' ` !� j�! <br /> 4 0 - -- ,33' I+1 1/4: W W %IA: S V) lfl rive y rm its <br /> ADDRESS (Sta , ,nty,town) <br /> Gii3e, - 35vi1)ERD mx-$141-l1, wr 5-356-` r- <br /> unitary permits _ l <br /> CSM: LOT SUBDIVISION SUBDIVISION BLOCK/LOT (public, rivate ��� <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: f� <br /> Lt CD X c�o Pp le_ ,)p ' s Q� onin District <br /> This project is a new building or structure. ermitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMITNUM L3 Rural Address <br /> [EWER R EPTIC I V (ne ,41�� <br /> ; _ <br /> HEIGHT IN FEET: 's- ^. NUMBER OF STORIES: (Not including basement) �� <br /> v Wetla •/F ••dplain/ <br /> •e - .n, (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST OOR: -/ Ero ,`nCo NI permit <br /> 4— ,c l� <br /> ) � ^ O y TOTAL SQUARE FOOTAGE: 4, (slope- •' turbance, <br /> fillin• . 'ess) <br /> 2ND FLOOR: �/ 3RD FLOOR: / <br /> V1 _I.,(/ QC II -view L•cation S ey <br /> ESTIMATED CONSTRUCTION COST: and availabE •• i•. s <br /> (Please round to nearest dollar) ♦ —. --o. -+ --I. $ 7'L) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes 0No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ENlo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ,®Yes ❑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) ❑Yes glNo ❑Don't know <br /> 7. Is this to correct a violation? :Yes ,No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -i -► <br /> 545-112(4/08) <br />