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5 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> L owe,0 H (tern r(Nan5 ID Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street.City,State,Zip) Deed Restriction;CSM <br /> y g I I (,,a:Sal►. hoick 9N J m c I•..d , 4/1 S 3 55' ' Variance(# ) <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS <br /> 60S-lig • q 151 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> T u„v j to Ggrrn 5 ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> Tyr) 6 u4Y I4-1a Y 51 <br /> (City,State,Zip) (City,State,Zip) 0 Setbacks <br /> ffN cr-asla4 , '"S 55552 <br /> PHONE PHONE ❑Site Plan approval from <br /> akD-a- 2>05 - a5 V applicable township. <br /> EMAIL ADORERS E-MAIL ADDRESS <br /> 51a1 1Q.Nli k"CUJttMcUtin5. <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: El Elevation of property <br /> 0 PARCEL t R 1 r frontage drawn to scale. <br /> NUMBER �b Q"O`�� • .l G C lam.° � /4" E .3 7 <br /> TOWNSHIP: SECTIION: <br /> TOWN DP '�Jt•1‘ C% 1A: `7C 1/1/.: % J Driveway permits <br /> ADDRESS: (state,county,town) <br /> 1117 VS I-i-i qlnway 5 <br /> CSM: LOT J SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> NI)ve 14046e_ Z�{ 1x 3 Z ❑ Zoning District <br /> This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER REPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 1. II ❑ Wetland/Floodplain <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> ,, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: fllling/acceSS) <br /> 16-8 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -11. -4. -I. ♦ `��p and available options. <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 alo Dpon't know <br /> 2. Is there a wetland or floodplain on or near the property? es Jo ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? I Yes [ro <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 Oslo don't know <br /> 7. Is this to correct a violation? QYes Illslo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -1 -∎ -Y. <br />