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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU OMER TO PROVIDE <br /> OWNER NAME n� <br /> Gera Id A Ir I I UVI Chery 1 A ■ d+hum [ ' o .ng Status; CUP; <br /> OWNER ADDRES (Number,Street,City,State,Zip) D ed Restriction; CSM <br /> bFS b5 C ++0 n d �Q U hal:c e W I 535 ariance(# ) <br /> 1 ME-PMONES.((( CELL PHONE-Q.A.ss/ E-MAIL ADDRESS <br /> 66-6(oq-a}., (eOCS-(D 7- 570/5 Gam 0-1'le • ►mot . I' cOYVJ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> l(RA� He y <br /> � ' E Site including location <br /> AGENT ADDRESS TRACTOR A . ell <br /> N Lia3 C± <br /> iT C De-orcat <br /> (City,State,Zip) (City,State,Zip) W z S353 a Setbacks / <br /> OWISVIAIP <br /> PHONE PHONE ❑Site Plan pproval from <br /> Co O - 7(o -L42`59 appli e township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: . CREAGE: P P y <br /> ElPARCEL yq`fg447 agq 5'i 13 p Q R 1-104(30 frontage draw to scale. <br /> NUMBER 1 b N 5ec.•34 -1 09 W 1�d 1 - NC �'"t3il <br /> TOWNSHIP: O S3],'.3p(��j-y SECTION , 1 <br /> V.; ey\y, I a g '/a: 1/a'/: Vv ❑ <br /> (state, <br /> 4S D iv wpermits <br /> ( eCyty,town) <br /> n)ADDRESS: <br /> (ab S P ' Y1 ad wa U ncatc WT- S 35 c n <br /> ❑Sanit permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (pu ic, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: 1r / / <br /> COnS+OACk■m DC �' Ci60n PartiL / ( X / 4 i oning District <br /> . <br /> This project is a new building or structure. Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ ' Ural ',e t1!. <br /> EWER IPEPTIC / V /A- new xistln• <br /> /1 HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> (--•See'a(aw;n5 cfavY1 W1. g�.5 ( W Ian. loodplain/ <br /> AREA TO NEARS T SQUARE FOOT: S orelarad (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ,,� <br /> rosionControl permit <br /> BASEMENT: 1ST FLOOR: a <br /> jQJ j TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> ❑ Review Location Survey NO)ESTIMATED CONSTRUCTION COST: ♦ -I. ♦ ♦ -� ♦ 7 5Q�J and available options. <br /> (Please round to nearest dollar) $ / 7 f <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? A- <br /> a es ,r"...1 o Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ' *;71 es o Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es /No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es '11No <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) QYes j2No ['Don't know <br /> 7. Is this to correct a violation? ❑Yes Fl. o <br /> 7( GO APPLICATION MUST BE SIGNED <br /> 545-112(4/08) 41 (Continue on Back) —r —r <br />