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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUST• ER TO PROVIDE <br /> OWNER NAME <br /> XAy of l�/*ew Iawi-er� C e <br /> v6"WNERADDRESS (Number,Street,City,State,Zip) Zoning Status; CUP; <br /> .5-.2 5-3- ncsPrwr�fror) PL Sin ai/,e le/ X3590 Deed Restriction; CSM <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS Variance(# ) <br /> ( � (092-d'l8 S I/ /tW ea� <br /> cCC2/1/147/-/eV'''�63 S. an drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and inclu dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> T/?) &uf1ie`, Si Ian including location <br /> A NT ADDRESS CONTRACTTORADDRE,SS of well/ <br /> (City,State,Zip) (City,State,Zip) S backs <br /> /�tco%san , W/ 5-3 703 PHONE PHONE ❑Site PI royal from <br /> fj05 _ 5-77 _ '/2 77 !cable wnship. <br /> E-MAIL ADDRESS E-MAIL ADD S <br /> 7,"7 6 eg- a„ei,., /e - l/' 4'c. Cop-7 F or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wl.us/) EI tion of property <br /> PARENT PARCEL NUMBER: CURRENT G: ACREAGE: P P rty <br /> PARCEL ntage drawn to scale. <br /> ❑NUMBER C�1 D,25t � C, 0- 1 <br /> TOWNSHIP: SECT! N: <br /> Tau'" '/ &,'4 ' 1/4: '/4+/,: ❑Drive rmits <br /> ADDRESS: (state nty, town) <br /> 5255 Preserves/fon fL Shin "/-4-,fv e / 0Jr' 535._�0 <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> El <br /> _ mits <br /> 2y (pu• . , •rivate) <br /> PROPOSED PROJECT INFORMATION : AFF REVIEW <br /> PROJECT DESCRIPTION: Acpia�-P 9 / .0O�/�/ $-�C /A,,e,4, <br /> J" <br /> • oning ' 'ct <br /> . is project is a new building or structure. P fitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: I Rural Add_— <br /> W <br /> EER E)EPTIC (n- n- (sing fr <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> Ili ► _ ...plaiN/D// PY/I/r9/ 9// <br /> •reland - i r ment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) • Er0 • <br /> BASEMENT: 1ST FLOOR: •ntr• •'m11t <br /> 120 + TOTAL SQUARE FOOTAGE: + (slopes d,` 1 •-nce, <br /> filli • «- ) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 1-2--0 ■ -eview L tion Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and availab options. <br /> (Please round to nearest dollar) $ ZD acsz <br /> A(._)) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes <br /> Kf <br /> ❑Don t know <br /> 2. Is there a wetland or floodplain on or near the property? Eves No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes No <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) Efres ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />