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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 1 <br /> D v(8- Chct 1. t(4Cc- i((A�C1' al Zoni Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Dee estriction;CSM <br /> Z2 N• BlY� 3f Sv r Pr r?e (J1 `J3 590 Var. ce(# ) <br /> HOME PHONE CELL PHONE E-MAI4 ADDRESS <br /> 2-11 - 2A,35 " ' ' d+ K 1 I t_r®l*L1, • (/SG• . Ckr>, ❑ Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> V-pq 14 waga Al-krYe. Dco /,/dmw LL C ❑ ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> 2??-2 I4wy ovi 2 ?2 isiIy mr� <br /> (City,State,Zip) (City,State,Zip) S: backs <br /> . 1-Cint0Lig w( 371( f Wi 33.7// <br /> PHONE PHONE ❑ ■ite P -n a•, oval from <br /> looe ({.S `Zl'i. 66 V 3 —2H-4 appl. -• township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> k 641 9 i R-C- L intS. W 6h(e; a cifinatp/1'tll, (;)M F 'for plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> ❑PARENT PARCEL NUMBER: G p CUR' TTNING: ACREAGE; fron a drawn to scale. . <br /> NUMBER Ot I1-32Z—/C10-6 ) <br /> TOWNSHIP: SEC <br /> 13V)5117 i a• IA: V'A) %%: J ❑Dri eway permits <br /> ADDRESS: <br /> (s te,county,town) <br /> I 7) 0 ? a . -ry permits <br /> CSM: LOT 1 SUBDIVISION BLOCK/LOT (p •lic,private) <br /> PROPOSED PROJECT INFORMATION AFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 3 D(\ 51v17le 4ai t ly Name 0 erring district <br /> . 14This 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: 04, . .= ,c � <br /> EWER EPTIC _ i3- 1��7 -QDOIa.? <br /> = is <br /> HEIGHT IN FEET: NUMBER O STORIES: (Not including basement) <br /> 2 ' , S e reland• (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) rosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> 1113 3 5 ,, TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> ��e1G6 ❑ Review Location Survey r.\0 <br /> ESTIMATED CONSTRUCTION COST: -11. $@ and available options. <br /> (Please round to nearest dollar) 38V i 00 U <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? JYes OVo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? f Yes 'lo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Efres Dlo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes IZINo <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) Dyes 'lo ['Don't know <br /> 7. Is this to correct a violation? DYes a,. <br /> (}t APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> i-f_S `� (Continue on Back) <br />