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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAI n <br /> CIS. JL /9 or;f2 a->J. �Ar.t 11 trc4.b_ � <br /> OWNER ADDRESS (Number.Street.City,State,Zip) <br /> y Zoning Statu , CUP; <br /> LD a E r.c z m3,-'.e p VJ Qy Rat ".4114.40,,, Deed Variance Re i tion; CSM <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS / �� ;5 Variance( ) <br /> 6O$- C64-2315 w.Q....Q a ra.t.-o�C 1 . ►••a: I.c,,►+ ❑Site Plan d n to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and include ' ensions <br /> AGENT NAME CONTRACTOR NAME <br /> TG. ,jtLva l o e, ar V;ve. I10 vv.a_ ( (•A►.s ►-•4vTio+.S ❑Site Pla cluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s ptic <br /> 4070 C Dr:g1....•.. a io' o E tr.:yam,.. Ri <br /> (City,State, City,State,Zip) ❑Setb v <br /> s <br /> 131 Zip) 0z 3 � 31, flc e.j 2 srs()f w <br /> PHONE <br /> PHONE ❑Site Pla from <br /> :i402"— L/ - - b l l 60(2 - (-(3) - L 1 ( applicab sip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ►"•'T Ck IL U C . • J Qvo)u t++..-LL a L( Sr C aQ %/G.l ,,,.Q ❑Floor plank td scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of pro erty <br /> ❑PARENT PARCEL NUMBER: `e� ,,!!// CURRENT ZONING: ACREAGE: <br /> NUMBER d3$/O)OT -04.at' 4- 0 It;l'l —2 g. y Co frontage dra to scale. <br /> TOWNSHIP::, SECTION: <br /> Pi.d a l e l.(/_m,— 06 1. /1/41 W .1/4%: N 1,v ❑Drivew- s <br /> E (state, sip■ 1 y, o <br /> wn)ADDRESS: <br /> (4)(o , ,.cKa►, o__f V &, Kd o / ildok. 4,J1 c oZ ❑Sitary permits <br /> CSM: LOT SUBDIVISION <br /> BLOCK/LOT <br /> yy 9 g 2. (public, - e) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJEC* CRIPT <br /> JJbM , , i wa C b�.� r( I <br /> ;a (,` ❑ Zonin0 ct <br /> . This project is a new building or structure. ❑ Pen-mull s <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER MEPTIC (new/e)I I ) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> I�0 (( `° ( ❑ Wetland/Flo dplain/ <br /> V Shorelan attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: <br /> ❑ ErosionCon of permit <br /> NA- /1(it) 4, TOTAL SQUARE FOOTAGE: 4, (slopes, s rbance, <br /> aC filling/acc ) <br /> 2ND FLOOR: 3RD FLOOR: <br /> u4 '/0 ❑ Review L tion Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ C?C) and avail le options. <br /> (Please round to nearest dollar) i \ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes No QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ®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? Dyes I 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 �No ❑Don't know <br /> ❑ <br /> 7. Is this to correct a violation? Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ <br /> 545-112(4/08) <br />