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P\C-X7r 5° <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App E <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME �,,` <br /> � �/�T (4-e i) n Zoning Status; CUP; <br /> OWNER ADDRESS (Number, City,Sltate,Zip)/� ` �, Deed Re tflC n; GSM <br /> /.ZDX -�,tY, / is Ao/ oRf r-/V �/ DCZ Variance ) <br /> HOME PHONE ,CELL�PHONE <br /> p� E-MAIL ADDRESS /� <br /> -2/I-/�d 0T a✓'ioQ Qc , mail•c-t '1 ❑Site Pla�dyr�n to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and incluUs dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> � -464/` ' BU//.D/as Cdt9 ❑Site Plan c Ing location <br /> AGENT ADDRESS CONTRACTOR ADDR SS of well/se IC <br /> ,O ' .3U it <br /> (City,State,Zip) (City.State,Zip) ❑SetbarLKS <br /> '. /J,4 J i <br /> PHONE PHONE / ❑Site Pla f:p, 0 . from <br /> 0 X- • Y —'?7.o applica:le :wnsh .. <br /> E-MAIL ADDRESS -►• <br /> 'za4 Ar, v;l 4t ,t_ E]Floor pla s o scale <br /> PROPERTY/LOCATION INFORMATION (httpJ/accessdane.co.dane.wi.us/) ❑Elevatio f perty <br /> PARENT PARCELNUMBERR: CURRENT ZONING: AC EAE: <br /> 111 NUMBER 0 /0X`12 !230d 27 frontage wn to scale. <br /> TOWNSHIP:/�,,ten SECTION: <br /> K /�-4Iv/ 1/4: '/a'/<: El Drive r <br /> ADDRESS: (stat co ty,t wn) <br /> /20 F� .S v N i W e /Q D 0 :640 J L✓/ 535-7� ❑s.• t. .,.e. <br /> CSM:'i�� LOT SUBDIVISION BLOCK/LOT (iii b eriv•to • 4 <br /> i <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: , ` <br /> 92 XS,/ pv 5A/44 ❑ Zoning t trict <br /> TIThis project is a new building or structure. ❑ Perm tt Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Ad ress <br /> EWER EPTIC (new/ Ist'ng) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> e—a/k) k ❑ Wet! d! In/ <br /> AREA TO NEAREST SQUARE FOOT: Shgtelktl (attachment} <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) F- <br /> BASEMENT: 1ST FLOOR: ECDSIO Gsy�l .'rmit <br /> 4, TOTALSQUARE FOOTAGE: 4, (slo.: ' . <br /> . r v ance, <br /> 2ND FLOOR: 3RD FLO�CO filli lac ess} <br /> �, 1 w ❑ Revie Lo rvey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ - QQ and a a options. <br /> (Please round to nearest dollar) $ 600 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes 'lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies Bo ['Don't know <br /> ['Yes 3. Have you talked with the township about your project and are they in agreement? Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Efres ao <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) Elves 'Jo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 0,0 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► -+ <br /> 545-112(4/08) <br />