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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CU •TOMER TO PROVIDE <br /> OWN R NAME (� <br /> Q er-,r\ t A. J-k--r-of.4 ill Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> L12-, 0:14.4 14oPe 26, , CO-1.4-a6L a c, wr 53s-al variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (DO:-_ .!=7. •S-3 35"-7a'/ KctrS 1 F) ' r_ L r a lig Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT <br /> Se\ - e\- <br /> E CO' QftNAME <br /> t'\I-(t' p Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) 4 Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> a licable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> oor plans to scale <br /> PROPERTY/LOCATION INFORMATION <br /> (http://access dane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER:: CURRE ZONI G: ACREAGE: levation of property <br /> ❑ RCEL 07"— ay-7147-0 ^ 0.7Yy frontage drawn t <br /> Cale. <br /> NUMBER <br /> TOWNSHIP: SEC f 1� �%. 311\) <br /> ❑Drivewa ermits C pT T ft t 62 0 0.: %:�j <br /> ADDRES ' (stat unty,t• n) <br /> 7 1/i.�H�s /�foP, RD co ivr_35027 ❑Sanita • rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT sub ,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> /��� M i <br /> �T4k STIR!46-r 5til-6(MO'EML - •f'ninDisthct <br /> . QThis project is a new buildin or structure. 64 itted Use? <br /> OThis project is an additio alteration to an existing building or st r . <br /> SANITARY SERVICE: PERMIT NUMBER: rA Rur. Address <br /> EWER EPTIC (n- /existing) <br /> HEIGHT IN FEET:/// NUMBER OF STORIES: (Not in ding basement) Wetland/F odplain// 1111 <br /> AREA TO NEAREST SQUARE FOOT: Shore! d (a - ent) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionC•,' •1 permit <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes •isturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/.ccess) <br /> 4/6g 44 r <br /> ESTIMATED CONSTRUCTION COST: � ❑ Review Location Survey 1 <br /> (Please round to nearest dollar) '♦ ♦ ♦ ♦ ♦ ♦ S 3 sa 6• ®e and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes Do ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ❑Don't know <br /> ® <br /> 3. Have you talked with the township about your project and are they in agreement? Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 'lo <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 No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (/'f\^\�� (Continue on Back) -1 -► -►1 ( 0,........0 54`x112(4/08) \�`J <br />