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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 /> V+rei; 1 ?(' �rrA. oning Status; CUP; <br /> / OWNERADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> (082-8 01H I I Raced , 1:L..... el Darvt W 1 5 3 SSS variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL:ADDRESS <br /> s 850- 522 i Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> SCE a t C6(1'�Yr�C "d✓' �.t-(6-, j . - 'roman ?Court ❑Sit cluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ell ptic <br /> N2-1G Sf Roca SS <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> Y PHONE ONEkuna' (r)1 54( 0-662.0 ❑Site P royal from <br /> C iz.o 7-59 . 332 ap ' township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> dbr:__,n ► Il(r6uital.Lan, F orpla to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn Ele ation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: A GE: _ p p y <br /> ❑NUMBER 090 q -3 1 1 ohog . _ A-1{- _ ntage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> .` /Qn� ,�4. ,�4,�4. Driv rmits <br /> ADDRESS: (St ,c nty,town) <br /> r <br /> ,.28 • 4 f ,_ . . . /: .� W 35- C Sani .\ • -rmits <br /> CSM: LOT SUBDI SION BLOCK/LOT <br /> .. (pu• irivate) <br /> PROPOSED PROJECT INFORMATIGN STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> rus-1-4t f 1 A d O(;-{t►r, ��q )-)1--Th Z ing istrict <br /> This project is a new building or structure. P fitted Use? <br /> This project is an dditio alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Rural®•'- <br /> EWER [)EPTIC (ne existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 331_ I) f7 i W-la-d loodplain/ <br /> / Shore - -d (attachment) <br /> AREA TO NEAREST SQUARE FOOT <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> Eros C. •ermi � <br /> BASEMENT 1ST FLOOR: ,,�Iii�±+` / <br /> ,{/ it'll— j TOTAL SQUARE FOOTAGE: + ••--, °• s urban <br /> 2ND FLOOR: 3RD FLOOR: `' , �/ X filling/ ?� <br /> 4 6, S S' Review Locat Survey <br /> ESTIMATED CONSTRUCTION COST: $ J^ and available op s. <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 NjNo EDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres ao ['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 11 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) ❑Yes @No ['Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ -■ -0 <br /> 545-112(4/08) <br />