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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> -1 v /, <br /> PD ,4L4/Sc9� LEDFoRY ing Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State, ip) <br /> 103 30,40„.5.,.. S ,.e.,--({7,.e.,--({7G/� {� 41)( eed Restriction; CSM <br /> l Variance # ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> k°$ 76 s °`6?5" Sit Ian drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includ dimensions <br /> AGENT NAME CONTRACTOR NAME 69,5 ..--,a-( <br /> rd-. Sit an including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS o well/sep <br /> i t/ r <br /> (City,State,Zip) (City,State,Zip).-. n Set•=. s <br /> {iter✓-74e/,i WI, 5-75-3/ <br /> PHONE PHON ['Site Plan as= •val from <br /> (C.)F 76 '( Z'/7Z applic- -town ip. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> F to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ONING: ACREAGE: c Ele n of property <br /> ❑PARCEL / i N1) " 1 rontage drawn to scale. <br /> NUMBER O�'� J�� D1-7'j� Q �'! <br /> TOWNSHIP: CTI N: <br /> 1.t r'.. 1 56 1/4: 5 w '/a'/a: 5,6, (-7 Dr ay perm. <br /> ADDRESS: state oust,,town) , <br /> CSM LoTk SUBDIVISION BLOCK/LOT ITK`a : permits ��// <br /> (pub' private) �1 ; <br /> • <br /> PROPOSED PROJECT INFORMATION <br /> -, ""STAF1? REVIEW <br /> PROJE pi DESCRIPTION: <br /> Ak -' 5tAfe 6v< < /4 e \-' Q c. -11 ,a. . iistnct <br /> . EfThis project is a new building or structure. W <br /> toed Use? a _ <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER. ❑ ``"' - .ddress <br /> FIEWER ;EPTIC /3.- 20/7 -- 4,0 2 g3 (new/e (sting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Z - .,Li _ ? 7 ❑ - and/Flood e,ain/ <br /> AREA TO NEAREST SQUARE FOOT: Shot nd Chment}' <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ` ❑ ro •neo • 'permit <br /> /�c� l-7�l , TOTAL SQUARE FOOTAGE: + (Slopes, ? urbance, <br /> d vv Q� lling/ ) <br /> 2ND FLOOR: 3RD FLOOR: , /�-- / / <br /> Lf 7 ,-,/ ? ❑Re ,:l.,•• Survey,: <br /> ESTIMATED CONSTRUCTION COST: li i °,, is °; ' <br /> (Please round to nearest dollar) "� -9 —4. -► -9 -9 $ 3� S <br /> -N ?T 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ❑NO is Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No ffl on't know <br /> 3. Have you talked with the township about your project and are they in agreement? Ekes LINO <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes o <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 ' on't know <br /> 7. Is this to correct a violation? Elves r` o v <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► --0 -► <br /> 545-112(4/08) <br />