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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NA 'G�aL /---‘2_54:, 0'7 a r -f n�J A <br /> in e '1 �ning Status; CUP;ADDRESS (Number, eet City,State, <br /> Z taf , / t-1�ssi� u i57z Deed Restriction; CSM <br /> M <br /> Variance(# <br /> )HOME <br /> ONE CELL PHOY IL ADD J <br /> ?`337- <br /> 'f''?l &a-3.53-04,6 not Q C-Le-Ael ✓1t ■ ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME /� i� CONTRACTOR NAME /� <br /> G--��y)r ''tom(Z. / W/°`i�►'� .4 ( CI Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1 �. /alp`„ M 1Ga1 �31 e .a,, si- ,oy <br /> (City,State,Zip) (City,State,Zip) backs <br /> iic■a Li l •533 q �0 .t..1Je� 1-A► 5 3517k- <br /> PHONE <br /> 1 PHONE ite Plan approval from <br /> pa. -7 ' (p 0 S © 6 O 7 - $ 7 r C so applicable township. <br /> E-MAIL ADDRESS E-MAIL A ESS <br /> S .c.c., e_e -c Uel-b�.defy.ca .� � <br /> ,Uc b„ ,',, , . ■ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACR GE: P P rty <br /> 0 PARCEL NUMBER 0507-093-3175/0 RN--.- • t - frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> P el '/<:TS V 1/4'/4: Riff Driveway permits <br /> �►r'cv 5>� (state,county,town) <br /> PODD ( ry own) <br /> ' "O �t't Sanitary permits <br /> CSM: y LOT SUBDIVISION BLOCtyL � <br /> 1 (public,private) <br /> N/ N <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / (� <br /> e---) �;n L -t”o.,,r,; n��.� ❑ Zoning District <br /> • �Jhis project is a new building or strlJture. <br /> ❑ Permitted Use? <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER TIC 1'_ ` ZQ I / — 001 ©Q (new/existing) <br /> HEIGHT IN FEET: F<p hi e le�i--.j'.c1 NUMBER OF STORIES: (Not including basement) <br /> � ‘ i Pe)/0)- 3 f c `'v� <br /> � ,jr", 4—AREA TO NEAREST SQUARE FOOT: ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1STFLOO�OR- ❑ ErosionControl permit <br /> Z4 6v j TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> l�v filling/access) <br /> 2ND FLOO A 3RD FLO // LI I CT <br /> 5-5614 4 1197 <br /> LI Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ and available options. <br /> (Please round to nearest dollar) ♦ ♦ $ s s©/ C�Q0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? rZis ONo ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? L�Te5 ENo ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? 2ces ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? s 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) Ores ENO Don't know <br /> 7. Is this to correct a violation? OYes to" <br /> APPLICATION MUST BE SIGNED <br /> 545-112 Iaroa> (Continue on Back) -+ ■ —, <br />