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p �( ,n <br /> ae-e-S_ <br /> kI.-e ��.(1 ( ' ./ <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> /il/Fro Lf JAA7ES /''DDE�2 Tr£S <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 9 Status;�C <br /> � <br /> o� ` �9�41Y9 Ave Variance Restrictidf;CSM <br /> Variance(# ) <br /> HO E PHONE CELL PHONE E-MAIL ADDRESS <br /> Tj° - 1, - °O . ii _ - - Nei ❑Site Plan drawn to*Idle <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimen ons <br /> AGENT NAME NTRACTOR NAME <br /> eorir Dotrees /r'l,D, gi L ��'�' ' 9 Site PI ul <br /> n ion <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/ <br /> tow( ptoese_ R4) — " <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> pDyidCrrS Wt /191.- '—Iiir <br /> PHONE PHONE <br /> ❑Site P n Mrom <br /> Avg r ‘3 •'-'- 7a. appli b ship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> r aV,ifi, ,r/ - ,e u r �►' ❑Floor plans to scale <br /> . <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL //,� frontage drawn to scale. <br /> NUMBER A1a�q(/p -pf3�?i/f- �r iCI 3 � /93 g <br /> TOWNSHIP: SECTION: <br /> pi 4 lh: %OA: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> ,>i 3 6 1494 CS i1 A•+t" i /4 li O Cs co., hit S37 it <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits �J u�1/� <br /> / (..� �posrc.r-i (public,private) `v �f �l <br /> hrt?Iw tsA' Seat 01 <br /> PROPOSED PROJECT INFORMATION STAPP REVIEW 1 t <br /> PROJECT DESCRIPTION: <br /> %irx Da,�.✓ es - 8,..m.D ❑ Zoning District <br /> [.This project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> [EWER jEPTIC (new/existing) ,� 9 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ❑ <br /> 3/ .:1: , Alf. <br /> AREA TO NEAREST SQUARE FOOT: <br /> SShoreland' , -. ', ), <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ EnCbrltlrol it <br /> BASEMENT: 1ST FLOOR: <br /> 474- �` 3v/ j TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> /, 7/o y 0/Y ❑ Revi= .4.-*: ;;V urvey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ 3� O OO and av 1® _ _ . •• <br /> (Please round to nearest dollar) O <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [ Yes Eslo Jon't know <br /> 2. Is there a wetland or floodplain on or near the property? ®Yes s10 9oon't know <br /> 3. Have you talked with the township about your project and are they in agreement? I Yes rLDs10 <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes a/o <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 al° ❑Don't know <br /> 7. Is this to correct a violation? :Yes iR to <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -► ♦ -. <br />