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.___g .;), \ ':. <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME I/0 <br /> J_ 1'QA Le, y ning Status;CUP; <br /> OWNER ADD S (Number,Street,City,State Zip) Deed Restriction;CSM <br /> 10 3 79 Cote n wd V mu-Z.o rn an 1 ej WI J`r3.�Z) Variance(# ,: .5 Q ) <br /> HOME PHONE CELL PH NE E-MAIL ADDRESS /� <br /> (po$-24:6 7oS/ /evo 4'Vd N 4,hoo.Co M Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> (,a )Q,, La_bo- Co, u,c 1 e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 8b3y mapce (xrk Pc <br /> (City,State,Zip) (Ci ,State,Zip) etbacks <br /> 1-10:6,(02., dui <br /> c).1/4c <br /> PHONE PHONE lam( 535T-4 ite Plan approval from <br /> cobs - 404 3 - a.g .i applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Q-FSr plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ation of <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ev property <br /> ElPARCEL ( -/o frontage drawn to scale. <br /> NUMBER 04/090�-2V-7030"7 (,a <br /> TOWNSHIP: °ECTION: <br /> _ma2o ma.,ni Q- ,= a? _ 1/4: &A) '/<'/4: na riveway permits <br /> 55-400 (state,county,town) /ADDRESS: <br /> 1037° n4 , Y me— orna,ni e, .OI <br /> , <br /> Mary permits fA <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) J <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ��,/ <br /> I(p' x9 ' cLnci 10' x 30` cL i-h�,s �b ek oL bui tli ry 'Cf Zoning District <br /> . ['This project is a new building or structure. LH rmitted Use? <br /> -This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: a mural A r <br /> EWER SEPTIC (new/ xistin <br /> HEIGH IN FE T: NUMBER OF STORIES: (Not including basement) <br /> C 1 6 �( ' etland/Floodplain/ <br /> I Shor nd (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: rOS10nCOntr01 permit /� �) <br /> 1414 SI + TOTAL SQUARE FOOTAGE: ,', (slopes,disturbance, /W <br /> 2ND FLOOR: 3RD FLOOR: `/ fillln /access) <br /> lizl S •P. eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ -► c oo and available options. <br /> (Please round to nearest dollar) J 6 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes 7 o Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes o QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? 'EYes IN o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes Efio <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank' none) <br /> 6. Is a location survey required? (see reverse) ❑Yes 2 o QDon't know <br /> 7. Is this to correct a violation? QYes !! o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ ♦ -i <br /> 545-112(4/08) <br />