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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU- OMER TO PROVIDE <br /> OWNER NAME 1 <br /> D N 1 44 f I w 1 W L •ping Status; CUP; <br /> OWNER LADDRESS (Number,Street,City,State,Zip) /� weed Restriction; CSM <br /> 7 /D -Sv vt_J jP/IrA-\ r ∎'e RP ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 40 `4 5---11S-- ❑Si Plan drawn to scale• <br /> AGENT INFORMATION CONTRACTOR INFORMATION a d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> $ P ❑ ite Ian including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS II/septic <br /> /'/'O-50m Pr(-it re RD <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site P approval from <br /> (0° (Q 55- fl TS' applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ElPARCEL 0f f 1 1 f &SGC_C R-3 � frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Y o r lc 11 v.4: S i ,/a,/4. NI tli El Driveway permits <br /> ADDRESS: (state,county,town) <br /> 1Hit7 SUr) PrMIiZ1`e Rv, Ali arS1,14II( U s- SSA <br /> C1 Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION ' :STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> .5c /a,X I I 19-An 0 ni 'N f-r 1,04_x Lv`-t1� 8)( 3‘'-i R on F 0 zoning District <br /> . ['This project is a new building or struc(ure. U Permitted tied?; <br /> ©This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Ratel Address <br /> EWER I-- EPTIC t e4iff, ,,,,) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> u( r I ❑ Wetland/Floodplaini <br /> Shoreland (attact ment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , <br /> BASEMENT: 1 S T FLOOR fry Dp w r Erasion ontrol permit 3RD 6.,1, •f l�� ^� TOTAL SQUARE FOOTAGE: ,(s s, turba , <br /> O' <br /> filling/access) <br /> 2ND FLOOR: FLOOR: / 3 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ --► ♦ ? and available options. <br /> (Please round to nearest dollar) $ J J (DC) <br /> 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes o ii Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Lives o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes lalo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? t:/ es ❑N <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank' none) <br /> 6. Is a location survey required? (see reverse) Eyes o ►A Don't know <br /> 7. Is this to correct a violation? [Yes JRNo <br /> Ile APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ -* <br /> G <br />