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... . <br /> r <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App At <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUS7hOMER TO PROVIDE <br /> /2,,,,.6, r /,--iskswh-ski y,_A,a ,S C F <br /> OWNERADORE8S 1Nwee.r.areal. "r:.�k0 ib ��---�I <br /> ,)7C Stow 2e °Ong Status;CUP; <br /> c7 41 L>,+.r.a s a4 , CAm 6K,pG.e, L) ( c 3 S a 3 Deed Restriction:CSM <br /> HOME PHONE CELL PHONE E.MAII ADDRESS Variance(# ) <br /> 970/cj-7111 Is- roskot� 9wta.;1 - c e— (� <br /> AGENT INFORMATION CONTRACTOR INFORMATION —r'si� n esdi a lion <br /> AGENT NAME <br /> «• ,:..•MAME::r arid includes dimensions <br /> AGENT ADDRESS ` �t•Ot\riUty% a■N �..�s. <br /> c OR ADDRESS — 0 S�Plan including location <br /> pt}weft/septic <br /> It:lh.��.�P, Lied!os I1,: _.Poll a ,:. <br /> (Car.Matte,ZIM / j @ ❑Setbacks <br /> PHONE /yA5 t- r rk,� pr .53Sa7 <br /> c� ❑Site Plan approval from <br /> E IwAILAODRESS 7- 531:::)3 c 1 applicable township. <br /> E-MAIL ADDRESS <br /> tow, YAr,,.•..t k1..,: ` • cc. • D Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpu!acccssdano.co.dano.w].us�)~ <br /> PAnCE N/M' . ❑Elevation of property <br /> t. ,y- O f?. 3L3-8500 " y . . frontage drawn to scale. <br /> TOWNSHIP: <br /> SE CTION: <br /> SCEWN <br /> 73€.Ji/ of C 1R/Sr,,gNA 36 %. SW ',ye. jJto ❑ ypets <br /> ADDRESS. (state.county,town) <br /> 2:a d1.-0 LUND RD, cAmg QiOGe A)/ 1-35-a <br /> csM. LOT summiISiON aLOCM.ol ❑ permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> STAPP REVIEW <br /> HA V SroR,AGQ.. <br /> ❑ Zoning D1sUict <br /> This project is a new building or structure. <br /> OThis project is an addition/alteration to an existlng building or structure. Permitted Use? <br /> sANrmaYSEER IA � PERMIT Nom: ❑ Rural Address <br /> 'HEIGHT IN FEE'E j NUMBER OF STORIES: (Not In:Wing bom,n e,A - (new/existing) <br /> rtg) <br /> '. I/ ii'&4 i y ,c / iN K ❑ Wetland/Floodpiain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions Including unfinished area,attached garages and above grade decks or porches) ❑ ErosioncontrW <br /> eASEMENE: permit <br /> ya Q <br /> 4 TOTAL SQUARE FOOTAGE: ,' (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR D IMing/access) <br /> ESTIMATED CONSTRUCTION COST: —'- a-o----- 0 Review Location Survey <br /> (Please round to nearest dollar) ► "► -+► -► -+ -► $ Viee) and avaNaWe options. <br /> 1. The properly is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes 1L$ (J on't know <br /> 2. Is there a wetland or floodplain on or near the property? Ayes o DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Dye <br /> 4. Has there been a zoning permit issued for this property in the past 6 years? es• a <br /> 5. is this project associated with a rezone/CUP/varianco(petition/appeal# ) • (leave blank it none) <br /> 6. Is a location survey required? (see reverse) Dyes `040 00on't know <br /> 7. Is this to correct a violation? Dyes ‘19.410 <br /> APPLICATION MUST BE SIGNED <br /> s.�,»woo (Continue On Beck) ♦ �► <br />