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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 /> /'HH/L k'*i T <br /> Ing atus; CUP; <br /> /OWNER ADDRESS (Number,Street,City,State,Zip) / / Deed Restriction; CSM <br /> V 7 g Z c K4- /2�N*'Z. L. 4 5v/V /324lg/t_ _ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL A'TRESS <br /> bi' 7 - - ' A 41 % ii Si a ' an drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION - d includes dimensions <br /> AGENT NAME /COOJNTTRRACCTTOOR NAME <br /> AGENT ADDRESS CON"Tf2p/f/Atc �� ,p® �� ❑Site P%s '- uding location <br /> /Oel I�Xid fT l hiii/K ' =���}����� <br /> (City,State,Zip) (City,State,Zip) ' ""'.._ <br /> PHONE PHONE / ❑Site PI approval from <br /> 6 e6 2/2.. 57 0 -7, a 'cable wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRE S <br /> /f f a YO e/ j1), ,S/ c g,p,�,it r plans to scale <br /> AGO H9 <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn Elevation of r ert <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p y <br /> El PNAURMCBEELR c S I -'tf-9OX) 4 k- 3A , cl rontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 5//V "1,if//Z/f''' N?r— 1/4: /,x/4: ❑ Driv ay p mits <br /> ADDDRESSC: ,�/ ,,/ ',/ (state, nty,town) <br /> 9&Z z/ �gv"-i M 5 '4 //,*",ZIL YY / ❑Sanita its <br /> CSM�q LOT SUBDIVISION BLOCK/LOT <br /> q / (pub'-,p 'vate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> N f W 4 Wing District <br /> . ❑This project is a new building or structure. P rmitted Use? <br /> is project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBE • ❑ Rural A.. - s <br /> FIEWER EPTIC / / A (ne o <br /> HEIGHT IN FEET: NUMB R OF 3/TORIES: (Not including basement) <br /> ❑ W-tla 140.,.,••plain/ <br /> Shor- • '1 (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1 ST F R: 1--, Erosio • rol permit <br /> ICI J j TOTAL SQUARE FOOTAGE: ,l (slope •' turbance, <br /> 2ND FLOOR: 3RD FLOOR: (� fills .faces`-) <br /> _ < 0 1-1 <br /> ❑ Revie ocati Survey <br /> ESTIMATED CONSTRUCTION COST: $ and avail le tions. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑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 ❑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) Ekes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545-112(4/08) <br />