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I/ <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CU• OMER TO PROVIDE <br /> OWNER NAME ,�l <br /> VT:, T /O c.&.) I`) p�+ Z ping Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) OQ,L,(�0--rl e.- ed Restriction;CSM <br /> `7 ("1 to CLQ 4 eon, 1`1 l\ 3)r■ \I e_ W iscc=,n6/N'' ance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> rV A ( -7IL- 4g 45 2 h il"owtut'rri -t-�5./)e - ''a Ian drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION a includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> `T Z..t-)\.)b(-T t-k ?3(J1 I S...O-eA-> ' e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> � <br /> { Z/z s--Kg< .A2cH ?�c K Pn e <br /> (City,State,Zip) r (C,State1Zip)V r� Setbacks <br /> PHONE PHONE I II Site 'Ian a oval from <br /> L O8 - / 1 .— 00 4}5 app ica township. <br /> E-MAIL ADDRESS E-MP IL ADDRESS <br /> 4 bS Q LION) t 4-f i -4 I, ,A LIA FI•or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane-wi.us/) IN levation of property <br /> PARENT PARCEL NUMBER: CURRENTZO G: ACREAGE: <br /> NUMBER o�r/�b—/. -,7'S- I _ I I8a /, 030 frontage drawn to le. <br /> TOWNSHIP: W SECTION:...1* <br /> ;ef } � <br /> ' t !,i <br /> t C'�` /j -1/4: 1� <br /> 1� : S ❑ Drivew permits <br /> ADDRESS: ' i <br /> (sta ,county,to .) <br /> 1G �V& l`�-+ f br.1'J� I 1I -R,.- A*'e . ( ❑S.ni permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 5 ici,sijr Pim •..lic,private) <br /> PROPOSED PROJECT INFORMATION /STAFF REVIEW <br /> PROJECT DESCRIPTION: (� <br /> iJ4i) e-f\1 �ce. -- Cot)C ej 5?"C�c,Q Q'\ C ■ oning District <br /> . ❑This project is a new building or structure. ` ❑ Permitte Use. <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural ddress <br /> EWER [XEPTIC I .) (new/e 'sting) <br /> HEIGHT IN FEET I q� NUMBER OF STORIES: (Not inclu ng basement) <br /> GT\ i, ❑ Wetland/Flo ain/ <br /> Shore' (attachm <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> 1ST FLOOR: <br /> BASEMENT ❑ ErosionCo permit <br /> C <br /> 4 TOTAL SQUARE FOOTAGE: 4,, (slope , Isturbance, <br /> 2ND FLOOR: 3RD FLOOR: fiI'I access) <br /> �—"^� a ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: $ 1 ) (('q© and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ D( J <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ,NNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 01'es ,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 jalo <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) Ekes SNo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ,No <br /> 4c)co Ar'S APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i --■ -4- <br /> 545-112(4/08) <br />