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P,IJS <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> LI NpA1JEg+ 17 AJE ci- EaR oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> $5t1 C/I6,S'1-+/lZE l-Sr LE 1'1/ / , QZONA 1 (N t 5-35-93 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDR SS <br /> 6,0 -i '9/g9 ,ii-51 _no P S ' , ,ri[Af rie Ill,gre—Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and incl dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 0551 C CA,601A pny c, [j,Slte Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1101 N, LEnN,oAVE <br /> City,State,Zip) (City,State,Zip) etbacks <br /> VVVVVV kin dU 1 6-3 Sq/- <br /> PHONE eE / ❑Site P proval from <br /> 6C8.,.BSb -11450 ap ' township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> '(l y' C o i ,1 . _ _S_ 'C a oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El ti <br /> PARENT PARCEL NUMBER: C RRE aon of property <br /> TZONING: ACREAGE: P P rty <br /> PARCEL f rontage drawn to scale. <br /> ❑NUMBER IQSbB '33L'OB�G'U 3 i to.' <br /> TOWNSHIP: SECTION: _ / <br /> Maya?' DSE •33 'y4: N E 1414: ,,,..vv ❑Drive mits Q�'1___\ <br /> + � ADDRESS: (sta -,count own ��P <br /> V Jg Q en zono .PP> Sanita ■- --..1 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑(public • <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> SIN6LF; rRtat(iy Pzlo l 401, ult_Di ) L g District <br /> . his project is a new building or structure. fitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER Ri$PTIC 12- Zoo- -00320 c t�W Listing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) • '�� <br /> /I ? Zg ,-1: loodplain/ <br /> ✓ ' Mel-nd ;L.! c ).-nt) <br /> AREA TO NEAREST SQUARE FOOT: Ilk, <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR ` rosionControl permit <br /> Al d il‘re �1 5 0.1 + TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> filling/access) S' <br /> 2ND FLOOR: 3RD FLOOR: R 0 <br /> 6 7 ii0 //S2 y.— view Location Survey <br /> ESTIMATED lease round CONSTRUCTIllar)COST: -► ♦ ♦ ♦ ♦ $ `©/ > � �D and available options. — <br /> Please r to nearest dollar) 6 <br /> °L a' g <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? EYes ❑No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes ❑No <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 ao ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes QNo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4108) <br /> (Continue on Back) <br />