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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME !� J <br /> /5a, ,er z- /`/'. -„/,jXANAI Toning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 221' Gir[E�/ a�4�C,S G//Q�E- <br /> Co 77-,74e- 1,,■¢o✓G wZ' 5-3517 Deed Restriction; CSM <br /> i Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 1,00)8z5--99 20 57S 9os/ X Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CNR'S GAS64 CONTRACTOR NAME <br /> BARREN Kett" S R�EY/��, ��I C. <br /> /1 e N /7o4S 4 .S/g. ;i6 Site Plan including location 1 AGENT ADDRESS CONTRACTOR ADDRESS p0.B•X Y84 of well/septic <br /> 11011 ri. BRis7nc. s-7-REED a/ 4.,k-IT I Nr"ECCO 5T. <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> Sv a ?Rc tE /+ZNrEcLO , wt 5"39 VI 111 <br /> PHONE PHONE ❑ Site Plan approval from <br /> (teo8) 83 7-'2K63 ((ood) 297- 2922. applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> b;.-rc•,IC.ti-@ spu.)l...2.-+ 4.)4,4,, w P••i5-G..."`- Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLus/) CI Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P p rty <br /> ❑ NUMBER 0811— 3k/3-o SW R-( U, 77/ frontage drawn to scale. <br /> TOWNSHIP SECTION: <br /> SAN ?RAMIE 3/4: 1h%: ❑ Driveway permits <br /> ADDRESS (state, county,town) <br /> Z2' 61-E,1 aAKSCIR.LE, C•trit4( 414d(,wS 53sz7 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> THE aAKS 7 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIf <br /> PROJECT DESCRIPTION: <br /> i %^ _ '� G4 O Zoning District., ; "'" I <br /> Y <br /> 1This project is a new building o structure. <br /> Permitted Use? 4/ <br /> ❑This project is an addition/alteration to an existing building or structure. ` <br /> SANITARY SERVICE: PERMIT NUMBER: /Rural °a <br /> W <br /> ❑SEER SEPTIC (n # t "i '"- ' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> we / <br /> h orelan. attabkirnen <br /> AREA TO NEAREST SQUARE FOOT: ( 'rge- <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ' <br /> ErosionCohtrbl perm 1ST FLOOR. (� 0 I TOTAL SQUARE FOOTAGE: j (slopes',7 `J pes;dis#urbane, <br /> fillinglaccess} aw <br /> 2ND FLOOR: 3RD FLOOR: <br /> 90a ,Ov y d W <br /> Review Location Bowe �ti� <br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ♦ ♦ ♦ ♦ $ Q o and available options, <br /> (Please round to nearest dollar) $ ) p . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 4KNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes )121No cr <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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -+ -+ <br /> 545-112(4/08) <br /> Q3. c() k v7I`. z_ 7 <br /> f if 7 <br />