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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 /> ' C PFeAY 4 /012-1?sf-A Sc 0v E'T'Z. oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> /0 22 E. bkge.$!DE" £',t, ED6e--,2.reiN, WT" 51 S 3 '-/ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 40g-21i- 8067 ,j a sc..6 ve.- "z-6 e."+n w i s •WM ite Plan drawn to scale <br /> AGENT INFORMATION ; CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Si Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> /D f ti/, NIi1-",44 CCE <br /> (City,State,Zip) (City,State,Zip) etbackS <br /> JANd✓,wE, tii 53548 <br /> PHONE PHONE ❑Site pproval from <br /> 60S-752—OS 75 appllNDA <br /> township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ogriPVin �dcombssurvey• Ct)r1 F rplanstoscale <br /> PROPERTY/LOCATION INFORMATION (http://accsssdans.co.dans.wl.us/) E ation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ onta a drawn to scale. <br /> NUMBER oSsao4Nq►f 000 4-Z )pq�I 2(. 637 g <br /> TOWNSHIP: SECTION:$/1�0t'SE At pp Sec1�/on Pi-:$-1 ewaypermits <br /> AL 13 o n/ %: /./4: (state,count <br /> ADDRESS:�i ] f <br /> �6 Hi I S t Ord nits •- its <br /> CSM: llo1'fB, P 112 LOT <br /> SUBDIVISION BLOCK/LOT ir <br /> (publ (, pnva- ) S44 <br /> Pot. t 3 Z A/% /A <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION:eoms 7RVG771,r✓ op-,# A/-lm, /1't^'t PE 6 nw NV✓e-in R>1 W•T-H <br /> O c t e s S Fk onA 1411-4-5 I P E 19-00‘1). DDistrict <br /> . his project is a new building or structure. rmitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ii `I ,r►!Address <br /> FIEWER NEPTIC /3 -- , Q 1 7 0 013 3 (y' Xlsting) <br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not including basement) <br /> /5i � i /� 1. ••• • <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ■I •..•nCOntIOI penni <br /> BASEMENT:_LI 0 1ST F I QR2 O disturbance, <br /> L_I/ (_,{? 4, TOTAL SQUARE FOOTAGE: + (�P�. <br /> 2ND FLO R: 3RD FLOOR: > full ) <br /> "3/ 3 Lo 0 2 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ Q J`� and available <br /> (Please round to nearest dollar) $ 1 V� 000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? IJTC' ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ..w.14.1 rek!.c..k4:" r.S Ees o ['Don't know <br /> Y <br /> 3. Have you talked with the township about your project and are they in agreement? :Yes allo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ONo <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 fNo ❑Don't know <br /> 7. Is this to correct a violation? Jes D4t) <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -i <br /> 545-112(4/08) <br />