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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWNER m <br /> 1"- 111.4-rVt 0 zoning District. ^"` '-i< <br /> OWNER ADDRESS (Number,Street,City,State,Zip) _ J e <br /> ,"l�.. I 1-4,...)-1 _ , OIL-r.-. - , lrj- 5 3S 3�-- Permitted Use? f//`� Lek <br /> PHONE E-MAIL ADDRESSL <br /> �6 -3'l,'13 �, A ,-,,�a /✓�rZ* O.441r— `Zoning Status;CUP;Erie__ <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Restriction; CSM <br /> AGENT NAME CONTRACTOR NAME Variance(# 10_ <br /> AGENT ADDRESS CONTRACTOR ADDRESS Site Plan drawn to scale Z <br /> and includes"dimens'.®- <br /> (City,State,Zip) (City,State,Zip) <br /> ❑"Site P -n'. uding location . <br /> PHONE PHONE <br /> =o - - .°ptic; <br /> E-MAILADDRESS E-MAIL ADDRESS r <br /> ❑ Setbacks <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) r ® e ° an approval from <br /> PARENT PARCEL NU//M��B))ER: ZONIN ACREAGE: c a Iicable township. <br /> p PARCEL NUMBER 0 !�V V/3 NC) ^ #4- <br /> TOWNSHIP: SECTION: <br /> LJ , 4- <br /> M co ' '/a: ,y r2t■ 1/a'/a <br /> e existing} <br /> ADDRESS: <br /> 'Tile �- 5 35 Z` i=Floor plans to scale <br /> CSM: Ls SUBDIVISION BLOCK/LOT <br /> P� Elevation of property <br /> PROPOSED PROJECT INFORMATION frontage,drawn to scale. <br /> PROJECT DESCRIPTION: <br /> 14°° 6. , 4-&4-&-v-2 Sem-4' , (?q-Qrn d / <br /> `4. B�`y A Driveway permit <br /> _` � <br /> (state,county ow <br /> . ❑This project is a new building or structure. ( Y <br /> X This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Sandi •'a e <br /> tar A1/141 ubllc, erivate ' <br /> Li SEWER t�SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Rot including basement) <br /> 1 I �� Wetland/Floodplainl <br /> ieland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) (-I"E�osionCOntrol permit <br /> BASEMENT: 1ST FLOOR: //S(Q es,#�ISturbanCe, <br /> ,l TOTAL SQUARE FOOTAGE: ,, 1 p <br /> .2'7(01 o27C�1+ )1(. =852 filling/access) <br /> 2ND FLOOR: 3RD FLOOR: _/� <br /> v ❑ Review Location Survey, <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ /2oa <br /> ,f;00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 74, o ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes i A No ❑Don't know <br /> 3. Have you talked with the township about your project? Yes C3 No . <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ii Yes .�{No <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (l ve blank if none) <br /> 6. Is a location survey required? Yes Cl No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes Akio <br /> —1. <br /> i- APPLICATION MUST BE SIGNED <br /> ' '1 , (Continue on Back) ■ -+ -► <br /> 545-112(1/08) <br />