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r ' <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUS OMER TO PROVIDE <br /> OWNER NAME <br /> Ti-VM4 AS 6 fry),ey,..N►s Ai F / T- 114 c-(,,.,n.9;s ■ oning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> t'.t�T .5 3 S$S" eed Restriction; CSM <br /> d9Yq 71 Ac►/ LIB grpu(G0) 7Di•J ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (ota 8 21-6Y•6 2- Go f-313 - )19 4 /plea/a.-)iSl®6!/4/ if- Ai a"T S'de Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> JO)1q M ije Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS iir well/septic <br /> (City,State,Zip) (City,State,Zip) 121 Setbacks <br /> PHONE PHONE El Site Plan appr from <br /> gYplicable nship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> l f toor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: EflElevation of property <br /> ElPARCEL . TS�J 3 q frontage drawn to scale. <br /> NUMBER 0 61I'-3o4-83 3"2. � <br /> TOWNSHIP: SE TION: <br /> Pi-f/4s/4,�r CM,AG s 1/4: 6P__ 1/1/: N ❑Driveway rmits <br /> ADDRESS: (state ounty,town) <br /> i'r <br /> agy9 TRAc. L,J STOLLG rev,, VI S3s8`� <br /> CSM: „ -y LOT ti N SUBDIVISION BLOCK/LOT ❑Sanitarypvate) <br /> 7,..3s. <br /> �s •ublje!private) <br /> PROPOSED PROJECT INFORMATION [STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Ll y so F - Abt7)-rio...7 'Tv ExcST„►,G t'--719 04ED GARA6'6 01 ning District <br /> . ['This project is a new building or structure. ermitted <br /> Elf his project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: NDNC PERMIT NUMBER: ❑ R ral Ad ress i. <br /> EWER PEPTIC ( ew/exi ting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> g 1 etland/FI plain/ <br /> Shore (attament) <br /> AREA TO NEAREST SQUARE FOOT: ,!cta <br /> 1 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionContfol permit / I I <br /> BASEMENT: 1ST FLOOR: J \ (' J <br /> 0 � 0 4, TOTAL SQUARE FOOTAGE: j (slopes, sturbance, ` "`JJJ�” /// <br /> 2ND FLOOR: 3RD FLOOR: filling/ SS) �1 <br /> O 0 L ❑ Review Location Survey i/l� <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ and available options.(Please round to nearest dollar) Q(', Q0 _ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? V es Olo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes 1fDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ['Yes IJVo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Elves largo <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) QYes [ Qo DDon't know <br /> 7. Is this to correct a violation? QYes <br /> L' eo APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ —► <br /> 545-112(4/08) <br />