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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 /> Zr1JPOit. RVPc10.1 ing Status; CUP; <br /> /WNER ADDRESS (Number,Street,City,State,Zip) <br /> 3 q PS- jW©Roilsk Ro riCi ,ON* ii J 1 5-3,9) 3 eed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> k(3-2-f $1 kici. 608-745"6-pie Sit an drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> CNM5Ttipr t 0WrIA>$oi l/ i3#als j•k/ 6'5, i/J%. Ir Site ' .n including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS o ell/septic <br /> 304 StCxerol Sr Jo& texo t f S/--' <br /> VCity,State,Zip) (City,State,Zip) IS Setb ks <br /> fin—, Hokfli, cr.,/ 5 z-7.2_ Mr de 11 v./,1 5'35'71. <br /> PHONE PHONE ❑Site Plan royal from <br /> /-4700- 1137'71/2- /4 c —'/ --6'3 . appli to ship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> wes+6.104-hOtke,5 C M k+ c. rat} wesi—Sxt(,e.hemGS 40/AA 3'C.f'+.4- Flo pla to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elev ion of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL e3g/c'jc,g- I91-0 lbb-a Ai /.75- age drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> /ADDRESS: 19 '/4: NC '/4'/4: p E El Drivew rmits <br /> / ADDRESS: (S , O ty,town) <br /> VV 3985" 5v.n8o1Nry tO MD <br /> ❑Sa -ry • its <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> g1r/-C,hCO 26 C'i,2,i,n,/k_ awAr t b (publi••rivate) <br /> PROPOSED PROJECT INFORMATION ST• REVIEW <br /> PROJECT DESCRIPTION: <br /> !x-r:) r®0.cri 1-7 ,r/ t1 Fll •nin District <br /> . ❑This project is a new building or structure. rmitted Use? <br /> 12 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Rural ....c.r7 ° <br /> EWER F4EPTIC iS) (new -xisting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) <br /> 7 'a if 1_ Wetlan• •* ain/ <br /> S - - an• attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> Eros • Conti', permit <br /> BASEMENT: 1ST FLOOR: <br /> j TOTAL SQUARE FOOTAGE: j (slopes, • - rbance, <br /> 1 3� filling/- a- s) <br /> 2ND FLOOR: 3RD FLOOR: <br /> Z0 . <br /> Review •, Survey <br /> ESTIMATED CONSTRUCTION COST: -► �i v�r •,,, and a ' -■ - options. <br /> (Please round to nearest dollar) $ 171 )n <br /> 1. The roe is within 300 feet of a stream or 1000 feet from a pond or lake? es [INo Don' krIPW <br /> property ❑ <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 21'es LI to <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes alo <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) aes 12No [JDon't know <br /> 7. Is this to correct a violation? ❑Yes a <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ —► <br /> 545-112(4/08) <br />