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246 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME y�� <br /> TI 1/11 i P erne ng Status; CUP; <br /> OWNER ADDRESS (Number,Streit,Ci ,State,Zip) Deed Restriction; CSM <br /> V. 3 i4 R /Y 1 1,041 te" l'04 Variance(# ) <br /> HOME PHONE CELL PHONE E-M S ADDRESS J <br /> b09-1.23q-0Q31) 1 .ler c2 e we/l w)h i, (p!Y) Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AG�yy,,T NAME CONTRACTOR NAME <br /> f L wi P.CDVC /D?cic criS Site Plan including location <br /> AGENT ADDRES CONTRACTOR ADDRESS of well/s is <br /> 7)e. S'{ 3'01411,5 5 4' - <br /> (City,State, ip) (City,State,Zip) aTRS <br /> (o g 2 (1 V-Q-- <br /> P dNE PHONE Site - -n .••'royal from <br /> L/ ()C99_2j7 b0 q4/ . appli . - ownship. <br /> E-MAIL AD RESS E-MAIL ADDRESS <br /> �G��d-i4' 6 F ..rp 'to scale <br /> � R w►�r'�Cpw� <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn Elevati. property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACR€AGE: P P y <br /> PNUMBER 010 O ARCEL C ./L.1 i, Q <br /> '—•.J / 1 , i g front - • .wn to scale. <br /> � 000 <br /> TOWNSHIP: SECTION: <br /> UY1 1/4:sIE '7/4: Drive, .y • - mits <br /> �Ow✓� r 3 (state, ••. ty,town) <br /> DRESS: n /^ <br /> 3)19 M0 1t Uleve' Yok Sa ' a• •- Hits <br /> CSM: � LOT � SUBDIVISION BLOCK/LOT (P ' GO <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> UeC g District <br /> . ❑This project is a new building or structure. rmitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Rural ` •• - <br /> FIEWER [EPTIC (ne -xisting <br /> HEIGHT IN FE, NUMBER OF STORIES: (Not including basement) p <br /> We+=• d/F ••. lain/ <br /> Shore . (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> Erosto , •ntrol s-rmit <br /> u SO j TOTAL SQUARE FOOTAGE: ,, (slopes,d •"fiance, <br /> 2ND FLOOR: 3RD FLOOR: / `J filling/-� s <br /> (150 Review Loca n Survey <br /> ESTIMATED CONSTRUCTION COST: r d and available o Lions. <br /> (Please round to nearest dollar) ♦ ♦ -0 --0 ♦ ♦ l 00 <br /> L,c, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes ,1No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes ENo ['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 V]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 NDon't know <br /> 7. Is this to correct a violation? Dies pNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4 —► -+ <br /> 545-112(4/08) <br />