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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App p <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWNER NAME <br /> ER It`, 'G h 401-R7" 7.- PE Zoning District • <br /> OWNER ADDRESS (Number,Street,City,Slate,Zip) , <br /> SS-1-0 (./)uC di- ,c0 f 40. O k�°-cj 0 k) 114;I 635 7 r - Permitted Use? <br /> PHONE p _ E-MAI(ADDRESS <br /> L�oP 5 73 __ 718O LI Zoning Status;CUP; <br /> AGENT INFORMATION CONTRACTOR INFORMATION D ed Restriction;CSM <br /> AGENT NAME CONTRACTOR NAME <br /> rARwe// Poo L5 — S 14111 r ariance(# ) <br /> AGENT ADDRESS CONTRACTOR ADDRESS �i <br /> 3g/t6 cau��` Ra A 6J t -ite Plan drawn to scale <br /> [ J and includes dimensions <br /> (City,State,Zip) v (City,State,Zip) <br /> pi A OISwo , (.V I 63718 • ite Plan including location <br /> PHONE PHONE <br /> 60 U 7-2. / 730 - well/septic <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> -PA WeII1'ecI �puy1'ES, AJer I - backs <br /> PROPERTY/LOCATION INFORMATION (http:llaccessdane.co.dane.wi.us/) ❑ Site Plan approval from <br /> PARENT PARCEL <br /> NUMBER: ZONING: ACREAGE: <br /> ❑ OS -q l'( —CI y 1/Pr L AC2c+s applicable township. <br /> NUMBER <br /> TOWNSHIP: SECTI � 1 <br /> 0Qe5OA) ,/4: ,/4,/4:, fS 1 • -uralAddress <br /> !! " v (new/existing) <br /> ADDRESS: <br /> SS40 LINCOLN 1 - _� <br /> CSM: LOT SUBDIVISION BLOCK/LOT ; LI F ' ' o scale <br /> 7430 / ■ levation of property <br /> PROPOSED PROJECT INFORMATION <br /> frontage drawn to scale. <br /> PRO CT DESCRIPTION: ? / ^� <br /> - it) /2OLi/a So)►'r L a 0 NA ' • Driveway permits <br /> . This project is a new building or structure. (state,-county,town) <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> Sanitary permits <br /> SANITARY SERVICE: PERMIT NUMBER: ' <br /> L I SEWER ki SEPTIC (public,private) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ❑ :tlalLdlFt0-56plain/ <br /> ________ <br /> - • eland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porche I. Ero-onC,g el-permit- <br /> BASEMENT: 1ST FLOOR: <br /> ,', TOTAL SQUARE FOOTAGE: ,, S s.:s,disturbance, <br /> fillin.;/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Re.iew Loeatron Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ �� O� \ --a 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 4 No ❑Don't know <br /> 2. There is 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? ❑Yes 0 No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes ArNo ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes I No <br /> d / - 2 3 a APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -+ —► <br /> 545-112(1108) <br />