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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App <br /> PROPERTY OWNER INFORMATION C STOMER TO PROVIDE <br /> OWNER NAME n <br /> &kt.l �/I ei t�r�i.�.,Nie C l -c Tuck 844-b✓' '41 Oning Status; CUP; <br /> OWNER ADDRESS (NumL}Jr,Street,City,State,Zip) Deed Restriction; CSM <br /> 13 y to Si P�1 H-Ac ,,�,,y e_„1 , / 53575 /Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS i <br /> a-45-)3 L)I ia-WS-CM d J 6a -k-er. i) 41 -4r'c'"'- d Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dierensions <br /> AGENT NAME CONTRACTOR N AME� / <br /> EA I e-f+-&�j ❑ ite Pla '+cluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS 1 of wel eptic <br /> �,`I lr.-r+��� ill-5)70s760,,‘ <br /> (City,State,Zip) (City,State,zip) T 3 M Setbacks <br /> / <br /> PHONE f r; <br /> PHONE El Plan,proval from <br /> applicaye t9*nship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> iloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑PARCEL 6,59-7 1 frontage dra to scale. <br /> NUMBER l�aj �1%1yNG-✓tri1 — Il g <br /> TOWNSHIP: to Li,l0, i-D` i S CTION: �� 7 <br /> D v'e .yv gbw o r4-/ %a: .�q�'h 09 Al k ❑Drive, pe mits <br /> /a/a. stat ,co town <br /> ADDRESS: r ' ( town) <br /> )31-1(a S : t-'►3L, -fC�I -1 gel ©Ye�� <br /> ❑Sani permits <br /> CSM: 1 13:}f.t LOT SUBDMSION BLOCK/LOT (pU C, private) <br /> PROPOSED PROJECT INFORMATION AFF REVIEW <br /> PROJECT DESCRIPTION: (' ■ <br /> G i V k' n c,. C ti's - 1a )1 t S C \S I n 0 Lning District <br /> This project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. • Permittefitfse?_. <br /> SANITARY SERVICE: PERMIT NUMBER: Li Rural ' •dre <br /> EWER EPTIC I\ �J (new/=■ isti • <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not in ding basement) <br /> ❑ Wletlan• lood• =In/ <br /> Shor- =nd r ment) <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: ❑ Erosion,ontrol permit <br /> Xj TOTAL SQUA FOOTAGE: ,l, (SIO•=-,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: ,-1 fillip!/access) „, <br /> ` /\ C3 Review Location Survey\ <br /> ESTIMATED CONSTRUCTION COST: --♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ 1 5 0 , , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [ Yes ❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 'lo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes Jlo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ®Yes ❑N/ <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (,leave blank ii none) <br /> 6. Is a location survey required? (see reverse) s o ['Don't know <br /> 7. Is this to correct a violation? Dyes JNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —+ -+ <br /> 545112(4/08) <br /> is j <br />