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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER /�J �-^ <br /> v,/--// Jet ES / /U1L�/ Zoning Status; CUP; <br /> / OWNER ADDRESS (Number,Street,Cit/y�tale,Zip) p /' /� r _ Deed Restricti9 " CSM <br /> --- <br /> �f7 7 �i48c- /J[.cI/y`' /`�� C�oSS /`"tea+-s fir. S�.S Variance(# ' `1.19 ) <br /> HOME PHONE CELL PHONE c� E-MAIL ADDRESS <br /> ,I/ v_ 7-341e- - I 72- ci •. I: &6,'ti9rL. -&Di°'t Site' n drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION , and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> /1.at-T1 _SA4.4-f ❑Site art,.ir 1i ding location <br /> AGENT ADDJRESS CONTRACTOR ADDRESS a�eptic <br /> :- 5/00/C4 PXC/SANG/_ lea <br /> (Cty,State,Zip) _ (City,State,Zip) I 1S9145k s <br /> \.," P24rA•re /Jo SAC 14. Sji-7r y <br /> PHONE PHONE <br /> 4 Si pproval from <br /> tDe_ 33/- o ?/3 `�ppl' /13I township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> F r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) /(' <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: n F Vation of property <br /> ri PARCEL NUMBER 000/ `l�Z-15'32.-q /r2. ` / 25 /7 ''TVif'rontasedrgwntoscale. <br /> TOWNSHIP: SECTION: <br /> B,.../tR y a v.: ,5E '/a'/a:,el.4f/ n •r •-w, permits <br /> DRESS: (st. -, 'unty,town) <br /> 8877 ram «fF /ed. &rr R-O l d✓. £1sz8 �-- <br /> CS LOT SUBDIVISION BLOCK/LOT } "'°ni .ermits <br /> V/ c> I i = (Pu• ': private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 61/64.0 44/6 p,,, Q arei 5oá' of 1 ,i/ OX oning District <br /> . ❑This project is a new building or structure. L1 Per Im tted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rura =': S <br /> ! <br /> EWER 5 EPTIC ' i (n- /existin� <br /> HEIGHT IN FEET: \ NUMBER OF ST IES: (Not including basement) <br /> fC ` p Wetly dplain/ <br /> • Sho d` attachment) <br /> AREA TO NEAREST SQUARE FOOT: .. _ <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) `--.._ <br /> BASEMENT: 1ST FLOOR: Ero ' nC trot permit <br /> 2ND FLOOR: i <br /> TOTAL SQUARE FOOTAGE: j i (slope , isturbance, <br /> 3RD FLOOR: j flll I acce ) <br /> / <br /> /�DOI I. <br /> % Revie lion Survey <br /> ESTIMATED CONSTRUCTION COST: -► -� I Nple options. <br /> (Please round to nearest dollar) $ 1/� 8��, 0 0 <br /> )11.0'1. The ro ert is within 300 feet of a stream or 1000 feet from a and or lake? es No Don't kno <br /> property Y pond ❑�' ® ❑ <br /> 2. Is there a wetland or floodplain on or near the property? nYes E4No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Wes nNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ElYes ❑No <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 ElNo ❑Don't know <br /> 7. Is this to correct a violation? nYes 121No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -+ <br /> 54,-1,2 14.".181 <br />