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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU•TOMER TO PROVIDE <br /> OWNEWME. <br /> 3'�o p h es.- M "^ 1 V ning Status;CUP; <br /> OWNER ADDRESS (Nuniber,Street,City,State,Zip) eed Restriction;CSM <br /> 3100 541- fil d TT n1.6. 1 `or4 ,w t 5-5c-t-L ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6,07 - 2 19-11- (.o • Z•'1-1-4-7-t- c -;st. how sm;4l,.5'...;44-,E) ' •w+. le Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Cie.cv ci C3,..,; Id'+4h Co r ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS J p- f well/septic <br /> 190 2‘+ 0(t St <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> Ve,-a►,S , LA) 1 5-3093 <br /> PHONE PHONE 0 It Ian ap val from <br /> (o 07- f,-1(s- - ?"7-'942' a lira ownship. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> iJ F or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: E[, evation of property <br /> IllPARCEL frontage drawn to scale. <br /> NUMBER 010/OCO.-al(-'f'3fio-o (1- J (Ex. <br /> TOWNSHIP: SECTION: '/. ` '/'/401 1 0 Driveway pe <br /> 1 owr, o f ell tee. ✓>n of✓.cis If 1°/��./1 <br /> ADDRESS: (state, ty,town <br /> 3100 3 }-I%yhw,i 9 dt'lT hor,G(,• LA)( b 35 I'Z El Sanitary p-' its <br /> CSM: LOT SUBDIVISION BLOCK/LOT .Ublic, vate) <br /> PROPOSED PROJECT INFORMATION AFF REVIEW• <br /> PROJ T DESCli ON: <br /> 7( C ea,,h M s.-k-al trot a (3 u∎ 14;1 /1 Zoning District <br /> . aThis project is a new building or structure. y P <br /> 0This project is an additio alteration to an existing building or strut ure. <br /> SANITARY SERVICE: Al(Kj PERMIT NUMBER: ❑ Rural A <br /> EWER EPTIC (new ,."` • <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not in acting ) <br /> / ❑ Wetland/F • •• <br /> AR TO NEAREST SQUARE FOOT: Shorela (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> E <br /> BASEMENT: 1ST FLOOR: <br /> p 1L 0' 4,TOTAL SQUARE FOOTAGE: j (Slopes, •'-' -'- •", n <br /> 2ND FLOOR: 3RD FLOOR: �ilig/ �* <br /> N g N I n l Z°" ❑ R- Location Survey <br /> ESTIMATED CONSTRUCTION COST: *� q (�� a • available options. <br /> Please round to nearest dollar) ('�J v <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Wes Vo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes aio ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Wes EiNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Wes ao <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) 0Yes Casio QDon't know <br /> 7. Is this to correct a violation? :fres fato <br /> APPLICATION MUST BE SIGNED <br /> 545 112(4/08) (Continue on Back) ■ -4, -► <br /> ...---- NO 1 <br />