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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CU TOMER TO PROVIDE <br /> OWNER NAME <br /> 1IAk SON LLB. <br /> Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> /V c3�7 '7#wN,A/ // ed Restriction; CSM ) <br /> �- ari nce # <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> S76' 7 .` .. , A .� a Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> awd77 Gv T6,14 ii, JAC- 6/4 ws/-Co :7-1g/Lt- ite Plan including location <br /> AGENT ADDRESS SS CONTRAC OR ADDRESS of well/septic <br /> I? a, /ac / z tV,,471 r /z <br /> (City,State,Zip) (City,State,Zip Setbacks <br /> Setbacks <br /> Mr, //Gyre'/% wl mss'S 7�- L 6/2_, 14/) S--3J-7 e <br /> PHONE f PHONE / ❑S. e la approval from <br /> °i - -79 6- 77r t ° rt- 77 6 7J1 P is le township. <br /> E-MAIL ADDRESS E-MAI L ADDRESS <br /> 4 _ `,c r . • t 9'Lcj/i■ w '.../it.-6" , s '.../it. ; aCcia44 oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT TEL BER: C RENT ZONING: ACREAGE: P P y <br /> ❑PARCEL 7 V7 .-� .,e16o-J L. c 1 (v frontage drawn to scale. <br /> NUMBER v vv <br /> TOWNSHIP: SE N: tt ,, <br /> C.,2 oSS /,4rs' 1/4: N N 1/41/4: A KA ❑ Driveway pe Its <br /> ADDDCR�ESS: L� (state, c nty,town) <br /> // �3 (cu NT f7/�/ �1—gc/T.-� V1 S-?.S-7Z ❑ Sanita► permits....(CSM: Cv,/� O LOT SUBDIVISION BLOCK/LOT <br /> (p�' c, private) <br /> PROPOSED PROJECT INFORMATION /TAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> CC),Q f � /J�"6, - ,trLi71/4-/ (---- I Jning District <br /> . This project is a new building or structure. Permitted .:? <br /> This project is an addition/alteration to an existing building or struct re / <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural , •dres <br /> r)EWER [)EPTIC I—,)4 (ne /existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> / ❑ Wetland/FI dplain/ <br /> Shorela (attach nt) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ Erosion' <br /> fOSIOnCO of permit <br /> S5 (12 / / 4, TOTAL SQUARE FOOTAGE: ,, (slopes isturbance, <br /> 2ND FLOOR: 3RD FLA./OR: /R: lQ flllln access)' –GT6 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: $ 75—/ and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ 1 ,5—c DO. o v <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes EINo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes allo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 21Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies 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) [Yes giNo ❑Don't know <br /> 7. Is this to correct a violation? Dies tlo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />