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ZONING PERMIT APPLICATION ww .countyofdane.com SUPPLEMENT to Web-App # <br /> w <br /> PROPERTY OWNER INFORMATION .q-�o CUSTOMER TO PROVIDE <br /> o�n(E''�M A ,l 1"s EA/1'1 toning Status; CUP; <br /> OWNER A,DLDR SS (Number,Street,City,State,Zip) 1;/9-a- � Deed Restriction; CSM <br /> 39 T ///� 7-, u000 A I V G20Nf} S?S 3 Variance # <br /> HOME PHONE CE L PHONE p if E-MAILADDRESS [� , ( ) <br /> 9--of 7 , �,, S e Mft C �P. gSite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 7,-A) - I-4 1 Al - <br /> 6 6 e/� D L ()C 24Vc" 76 4JS to Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 9 -7-0 (2-P r."-* Prjes c <br /> (City,State,Zip) (City,State,Zip Jetbacks <br /> it/1- 6 I S o 4 )/ 537/7 <br /> PHONE // PHONE i el an approval from <br /> &U r - S 7 7- f9/l0 (Poe• g3/. 08 o/ applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS �y� <br /> b velthe d es/.hs 4o, Id , ,/ t: EiKi°or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT <br /> PARCEL NUIyIBE2R: CURRENT ZONING: ACREAGE: [Xlevation of property <br /> O PARCEL o f7o Q- Jl� -di2P,D g <br /> (J Q - 1 A fronts a drawn to scale. <br /> NUMBER 1'�1 <br /> TOWNSHI : SECTION: <br /> -f'41 A) 6FeL--b 3 ) 1/4. .1/41/. [Driveway permits <br /> ADDRESS: (state,county,town) <br /> So3Zs1 Na ,61LC)SS®/11 [Sanitary permits <br /> CSM: LOT S BD ON )aN D BLOCK/LOT ry p <br /> r i.912771/n�r/ (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PR JECT DESCRIP N: <br /> Y .-( ) CPN S l�C. l/O 2 Zoning District <br /> • This project is a new building or structure. Use? ✓ <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 0 Rural Address <br /> HEWER \EPTIC /3_ :c7 0/7 0 a-// (new/existing) V <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) �y� <br /> / ® Wetland/F000dplain/ "? I <br /> Shoreland (attachment)• =Alai to <br /> AREA TO NEAREST SQUARE FOOT: c•al'OL <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: J�ErosionControl permit <br /> �" <Tj� Q 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, V <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> �/ gt7 \' [Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) '♦ ""∎ '♦ -4, '∎ 600 0 ® D <br /> 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres ao QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes o DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ..• Wes Vo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Wes JVo <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) 01'es alo []Don't know <br /> 7. Is this to correct a violation? []Yes Jlo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4108) (Continue on Back) -► ■ -► <br />