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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 00 i i.''1 Up ls; C_S Oning Status; CUP; <br /> OWNER ADDRESS (Ntenber,Street,City,State,Zip) <br /> Deed Restriction; CSM <br /> go01 F trite r' Variance(#GL{n'i ( ) <br /> HOME PHONE CELL PHONE E-MAILADDRES (� <br /> 60 r., 5-g"--076y S4,- `1 e f j sir e fJ/ C°''"P,.,y'' f Ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> A NT NAME CON ACTOR AM <br /> a u l S Oe �4 A Ci,t.s7: LL-C__ J Ot v�0 - r4 U/-S ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> Z C32 A1o(w,rc/4 S <br /> (City,State,Zip) (City,State,Zip) // ❑Setbacks <br /> /` , -f-cA 6,./0 / h�-L- 5378 <br /> PHONE PHONE C ite Plan approval from p4 <br /> Co sA7J —Zl 7r applicable township. �/ <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> K J �,Ls e po c -scio oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evation of property <br /> PARENT PARCEL NUMBER: /� CURRENT ZONING: ACREAGE: p p y <br /> ❑NUMBER 07 IC—Q35—qv 9 C -" D U • frontage drawn to scale. <br /> TO HIP: SECTIOy•, ' I, , s,� riveway permits i <br /> L100,.� ,`k, t,(v ye_ <br /> /4: �� /4/4: (state, county,town) <br /> ADDRESS: J <br /> Cad 3 Fe vo r l t-L °` kr 12(---..•ary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> pus lc,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT D C IPTION: 11� �/� <br /> t`frn0✓1 — SeCv (L s\ p a(4ICQ_, (-es-I-room Oning District <br /> . ❑This project is a new building or structure. ermitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: L KUfal As s - <br /> EWER [REPTIC (new/-xisting) <br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not including basement) ,� ,/ <br /> Z� 0 0 L k tland/Floodplain/ N <br /> AREA TO NEAREST SQUARE FOOT: � Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) Ll ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> 0 7 actin 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) -- �a. <br /> 7 alb eview Location Survey Q�S <br /> ESTIMATED CONSTRUCTION COST: -► ♦ -�► � O/ S OU °—■- and available options. <br /> (Please round to nearest dollar) (/ .C) <br /> 1 G Qr64;114 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes Nlo ❑Don't know \tom <br /> ❑ <br /> 2. Is there a wetland or floodplain on or near the property? Oyes �No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [E]Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes [INo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (le-ve blank if none) <br /> 6. Is a location survey required? (see reverse) (4� a o Don't know <br /> 7. Is this to correct a violation? E-es I NNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -* - <br /> 545-112(4/08) <br />