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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 /> /4rM '7' LerwK ei oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,tip) <br /> -2 715- 7 t 1) L,,c S- Deed Restriction; CSM <br /> '� R Arid�K��wD Variance(# ) <br /> HOME PHONE CELL HONE E-MAILADDRESS <br /> �VZ19'11 4..)LO W"C. 010 • iv.",` *co... ©Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ‘'4`'AE O Site . eluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS ell/s tic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE /'* < E Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> © Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> ElPARCEL PARENT PARCEL NUMBER: CURRENT ZONING: © Elevation of property <br /> NUMBER Dbto-b��"6(22-Z (23 ,.. frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Du.40 .1/4. sedaLmet 1/41/4: ❑ Drive per s <br /> ADDRESS: (state, c ty,town) <br /> SUS. • Ett M MC Plain }AII wi, S3SSIi Sanit- • m is <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> ':- , •rivate) <br /> PROPOSED PROJECT INFORMATION - <br /> PROJECT DESCRIPTION: <br /> ST F REVIEW <br /> A/E"' 064R OCtig s' L*fhb s 0444 oning District <br /> • Ethis project is a new building or structure. Pe fitted Use'? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMB ❑ Rural Add - <br /> ,lSEWER FT EPTIC /4!/4. (new *ow <br /> HEIGHT IN FEET NUMBER OF S RI S: (Not including basement) L/ 1 t <br /> iv Avt f d— <br /> CI Wetland/ oodplainl J_�11t-,� <br /> AREA TO NEAREST SQUARE FOOT: - ® "rttnen# <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT: 1STFJO — ErosionCo trot •ermit -' <br /> It-)s} 1) \Q �� 1 TOTAL SQUARE FOOTAGE: + (slopes - rban•.- 0 r <br /> 2ND FLOOR: 3RD FLOOR: \ ��1 filling/a~ l� <br /> / Zilevtew Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ �� nd available option . <br /> (Please round to nearest dollar) — <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes ONo ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes ONo ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? QYes ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [ Yes :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) QYes ONo ODon't know <br /> 7. Is this to correct a violation? QYes [alo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) <br />