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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 /> � '€ �/l/(f oning Status; CUP; <br /> OWNERADDRE�Nu i er,Street,City,State,Zip) Deed Restriction; CSM <br /> 7C(0 y (..$✓r1 ►YL )' A C ( c q Variance(# ) <br /> HOME PHONE CELL PHONE E- AILADDR S / <br /> �I -7 Sz r t W_a Pl o`: ` G p? ,, mi . e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONT CTOR NAME <br /> 6f `0 Ite Plan including location <br /> AGENT ADDRESS CONTRACTOR DDRE' s " of well/septic <br /> 79oq c ( 4 rd( `)//' <br /> (City,State,Zip) (City,State,Zip) tbacks <br /> ✓VCGc w S <br /> PHONE PHONE 4 e Plan approval from <br /> oq—L jq c- '7 Z applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evation of property <br /> PARENT PARCEL NUMB : CURRENT ZONING: ACREAGE: <br /> ElPARCEL „ 1 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: c.37 07:S - 1 3_wt3,)SECTION: ' , l 1 <br /> M id dtp.-�-6teN ( ck '/4: S '/4'/4: p W riveway permits I <br /> (state,county,to wn)y/4 <br /> ADDRESS: cloy I� <br /> 7 loy stx/„^Mur*zt ja an anitary permits / <br /> CSM: LOT SUBDIVISION BLOCK/LOT / i <br /> (public, private) ���/// <br /> 9 # SVA 'Pa 'ail <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: �, <br /> Ojai--bu Id ( u-zoning District <br /> . IThis project is a new building or structure. Q'Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. �1 �t <br /> SANITARY SERVICE: PERMIT NUMBER: ural Address <br /> EWER r=kr< (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> S f D 1 / LI‘tland/Floodplai <br /> Shoreland (attar <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 7 1ST FLOOR: rosionCOntrol permit <br /> / c) y n s j TOTAL SQUARE FOOTAGE: 1 (slopes, disturbance <br /> 2ND FLOOR: , // c) <br /> 3RD FLOOR: / `-(G filling/access) <br /> /t/ e) A0____zq z, X2 3- 77O R ew location Sury / <br /> ESTIMATED CONSTRUCTION COST: -0. -1. ♦ -11. and available option <br /> (Please round to nearest dollar) <br /> 5*, 60 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres igiNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes NNo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? es No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es EjNo <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 ['Don't know <br /> 7. Is this to correct a violation? Dies No <br /> Y`(1P� N o.N c o -m L)I <br /> APPLICATION MUST BE SIGNED <br /> \` A. <br /> 545-112(4/08) (Continue on Back) ■ -► <br />