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ZONING PERMIT APPLICATION www.countyofdane.com supPLEMENT°towebapp# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME I <br /> /?0 /3z-/=f v Tv / I i �f1(/ef2-- I N Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> �/ n '/ �., q'eed Restriction; CSM <br /> �T Z on-6 4/1/08 i/tricN/ tJI. S 3 S-/3 tariance (# )HOME PHONE CELL PHONE c O 7) E-MAIL ADDRESS <br /> 5-7.5--- IZ8 ��S'te Plan drawn to scale <br /> -AGENTINFORMATIOIC• N_TRACTOR•INEQRMAkTION - — - ,nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME :r <br /> /fc71/5L-,u 8t,iic/ k 5 . tip : yC,vSe--.-, 6c,(d gs 7A/c, �ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS pf well/septic <br /> /70eitf-�-jL 5/: st;i 4-, g %/06//f-:/e S7`. S'1 71 t <br /> (City,State,Zip) (City,State,Zip) 1 liSetbacks /-- <br /> 14-lg o/vd GJ 7. 5-3 S-92 G(19 pw.f-it 417. 5-3S---- ' <br /> PHONE PHONE n Site Plan 9,pproval from <br /> C ? - Y V%- v 7>6 `0 y- y V — %7 l PPlica township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS r <br /> Atkiceu 6v, 1e£'w_; %O S., i-f h&�� N 6 v,/ as_-�-7-o s. /v� T Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLus/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: frontage drawn to scale. <br /> —NUMBER // /_ / A 7C- <br /> j <br /> TOWNSHIP: SECTION: ` <br /> 5,12' a/.775 y2 4, 1/: 1/41/:— gDfiveway permits <br /> (/State, county, town) <br /> AD ES (k.j <br /> t. �!A. 6) -L-1 4Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (OUbIIC, private) <br /> /Oy// V (1 <br /> PROPOSED PROJECT INFORMATION TAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> /Lk.w 51 Aly /. _ .oda.v, /7 /99 u ///A J \A 0r2_ e.,5,}- 'j Zpriing District <br /> RThis project is a new building or structure. ermltted Use? <br /> fThis project is an addition/alteration to an existing building or structure. " - <br /> SANITARY SERVICE: PERMIT NUMBER: CI ralAddress <br /> EWER SEPTIC /3--,lo/`7 --av j(� (new XlSting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) . <br /> .5):y(- l' / ❑ Wetland_PoOdplain/ <br /> ' "s or lArd (attachmen ) _ w�� <br /> AREA TO NEAREST SQUARE FOOT: S <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> EroSionControl perm - <br /> BASEMENT: 1ST FLOOR: ,, •-' <br /> ,) 5-0 -� per= //O <br /> 4, TOTAL SQUARE FOOTAGE: j (slopes disturbance, <br /> "� °' filling/access) <br /> 2ND FLOOR: 3RD FLOOR: („ <br /> -.�-7i-t'1 tok ro ❑ Review Location Su =y' <br /> ESTIMATED CONSTRUCTION COST: �� and available option C� . <br /> (Please round to nearest dollar) -► -► -► -► ♦ J /O� o��/ P <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [—Yes t[iNo I Don't know <br /> 2. Is there a wetland or floodplain on or near the property? nYes RNo 1 Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? LYes No <br /> n <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yis I �No <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) (lepve blank if none) <br /> 6. Is a location survey required? (see reverse) `■ fYes 1' I Don't know <br /> 7. Is this to correct a violation? Wes �l�o <br /> "Y s 90 APPLICATION MUST BE SIGNED <br /> 1 (Continue on Back) -- --t. —s <br /> 545-112(4/O8) <br />