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ZONING PERMIT APPUCATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME /y� p (21-1 l <br /> Rose-rn oil 11larcie-c b- A 1c-& �f f 1A(lt"— ®Zoning Status; CUP; <br /> OWNER ADDRESS umber,Street,City,State,Zip) Deed Restriction;CSM <br /> Jaa( 01 SIQaj LLPI..oa4 1 S "uqi"L(z1) SCO S3SU ) Variance(# ) <br /> HOME PHONE `-C E-4A <br /> fo0$"a 19 -co • I`dSe_@,I ice-to I re-. 0)e ❑Site Plan drawn to scale.swe <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimert$ion ... <br /> AGENT NAME CONTRACTOR NAME adr" iv .5e....6 / if <br /> Al" uI IS 01m rs h Se frx Cr Ftij [Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> N gB-Prooie ss tavy I orb <br /> (City,State,Zip) (C" ,Stat ,Zip) Setbacks _t0 1" <br /> Pra1rie Jo 535)0 <br /> PHONE PHONE /4 Site Plan approval from <br /> 60g-%-37. 4 9 0 0 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS • <br /> '4101 e, P LT-u 5-4-, c0 m ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: (� CURRENT ZONING: ACREAGE: El Elevation of property <br /> ❑NUMBER 0 Si v 3 i 1 4p 7 0 1 R H -f 3• a frontage drawn to scale. <br /> TOWNSHIP: SECTION: [� <br /> RLCV I a4 Cl 1 4: 1/41A: 10 Driveway permits <br /> ADDRESS: U�nn rLL 77-- (state,county,town) <br /> 3a a Co Old Stage, U 64Yf7 v,i , 4)T 5-3 s& 9 ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> 1.--441 D <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ,� <br /> 3 swiled Horse. Shed, St-all LO In 6/ TQck ko©i ❑ Zoning District <br /> . <br /> This project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> {)EWER PEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 10/e 0 n e-- ❑ we tland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> a u 01 1 TOTAL SQUARE FOOTAGE: +, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> ay 0/ ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -. -. -10. -r -41. -, $ <br /> and available options. <br /> (Please round to nearest dollar) 5) DO O <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ..... Efres alo [on't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑tries Flo Eon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes CNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ®Yes alo <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) ❑tries Do Doon't know <br /> 7. Is this to correct a violation? Eyes EiNo <br /> APPUCATION MUST BE SIGNED <br /> 545-»2(4m <br /> (Continue on Back) —► —4. <br />