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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME p <br /> `jai r • ./jW// 7�i�.M-./) oning Status; CUP; <br /> WNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 5?67 d g r v i/1 �1Q/ .d, (il/i 5 370`x'/ Variance(# ) <br /> HOME PHONE GEtt'PRONE E-MAILADDRES <br /> 6D/ , 6, u- 4 x61Ed, b1 �tf6A 'N/ Si Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includ dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 4477" j g/!/F GG --p' !fi N7ig4-‘ <br /> k/1/ 5- Z.6,e- e Plan including location <br /> AGENT ADDRESS COf4TRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Set cks <br /> Avt,iili'.�l / wl 73 597 <br /> PHONE PHONE ❑Site PI pproval from <br /> (.P 0 V' 7 7C-I/332 ap . able wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 0/N -/q 6.01,i,/,i ' , 0 i oorpla o scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn ti property <br /> PARENT PARCEL NUMBER: CURRENT ZONI vation of <br /> G: ACREAGE: p pert <br /> ❑UM ER D�i O CC/ %•-c:)0 p— 3-_.? <br /> rontage drawn to scale. <br /> TOWNSHIP: SECTION: uj <br /> 0021,/e-S/,/ N In! 1/4: 5\13 1/41/4: ❑ Drive - • it ��.5�' <br /> ADDRESS: (Stat= �;�1!''�OW <br /> g Y -� � ) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ry permits "fit/ <br /> (publi igilW v, <br /> Ilia•]1•1.14�»;t• , • ; _ • TAFF REVIEW � /- <br /> PROJECT DESCRIPTIO 1 <br /> p�()✓`_� -tc� c 1 R Zonin 'strict <br /> . <br /> This project is a new building or structure. rmitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 11 Rural A•• ess <br /> EWER EPTIC /A )t 4-C( -rto.., (new ��` <br /> Y tE/ new -xls In• <br /> HEIGHT IN FEET: NUMBER OF STOR S (Not including basement) e'er !] ; / ' <br /> AREA TO NEAREST SQUARE FOOT: Re <br /> I S •: .nd attachment) _c- <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST ORO ErosionControl permit <br /> j TOTAL SQUARE FOOTAGE: +, (slopes,disturbance, <br /> filling/access) "—'- <br /> 2ND FLOOR: 3RD FLOOR: ^ �0�� ~'� <br /> • / Review Locati Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ -► ♦ and available opt« <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? .0-,Z es ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? �"-s ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ,` es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? . vs 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 . to ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes -EINo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) <br />