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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 /> (mes- suj,//tom oning Status; CUP; <br /> WNERADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 1///7 .1o/7f V^ c w <?v( (/awn a. (AI = 535 ' Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADQRESS <br /> ‘60 63J 7$4 7 f,08-.?s'3'/0.s'7 OFVa.leme.ta? e rds .�zt <br /> ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRA�(TOR NAM Y`-- , ( , �,I <br /> I i L es ��T YIF'LA(�ICTY .__, a Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> boos 14pPA <br /> (City,Sta ip) (City,State,Zip) _ etbacks <br /> HONE nckee 5'c 7 <br /> HONE > ❑Site la proval from <br /> (0Og')`g y9—g32 1.2 i�..Cl )o1�wit/ app. e township. <br /> E-MAIL ADDRESS MAIL DDRESS <br /> k.6.2 • --ets.t> - 11,1-itl-cirPans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: IOn Of property <br /> ❑PNURMCBEEI 038107�D-13(1-360710 -2 �-73- I ,D lQ� frontage drawn to scale. <br /> TOWNSHIP* ft -1 / SECTION: <br /> N' t 4-e-4-orl I g '/4: '/a'/a: ❑ Drive is <br /> ADDRESS: tat , cou , town) <br /> Lfri7 Lbr gvtev.) k-e Vtrrrna ,►� $3543 ESa i _' permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT Yô <br /> ++ii �1 A- to 1t�cl. <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: l <br /> r 0.� 14 ?(-36-/ pe-,s S`/ o/���e-� Wog oning District <br /> This project is a new building or structure. <br /> p J g Pe ed Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: D Rural '"" -: <br /> EW�ER REPTIC pv E / ew'-xisting <br /> HEIGHT IN FEET: I / f, NUMBER OF ST RIES. (Not including basement) <br /> ( 4'r 1 D Wetia .. .• ain/ <br /> \ J AREA TO NEAREST SQUARE FOOT: Abe ® a merit) <br /> � <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> ©l =-rosin • 4f• •ermit <br /> 9/G 1 TOTAL SQUARE FOOTAGE: 1 (sin.,=„.• rbance, <br /> 2ND FLOOR. 3RD FLOOR: <br /> hilt g/access) <br /> E 1(O Review Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ Q and avaate options. <br /> (Please round to nearest dollar) $ 7-t),00 0 <br /> Yf' S <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Des 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? Elves EANo <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) Dies ENo ['Don't know <br /> 7. Is this to correct a violation? [Yes 5-1.11No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br /> -+ ♦ —, <br />