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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 /> .T.cy\S v\ LLC _ []v�zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) �/�`,,��� Deed Restriction; CSM <br /> HO PHONE J6 s1 1' , E-MAIL ADDRESS <br /> 537 l9 Variance(# ) <br /> il rake) -Co510, la's ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> �\C,LI 1P)1---k �;Y-��1� j rreSo., VI ( kzS ite Plan including location <br /> AGENT ADDRESS `Q CONTRACTOR ADDRESS 1`� of well/septic ),J k <br /> asp Via' f3 v6 27-�kSo 0-g-)`r <br /> (City,State,Zip) (City,Stat ,Zip) ❑Setbacks <br /> CD EC-fors t��l � 1-1 S d �l W\ <br /> PHONE I PHp ite Plan approval from <br /> (�S_ r3o)— I 12] r)rj- i - � 3. applicable township. <br /> el- <br /> E-MAIL ADDRESS I E-MAIL ADDRESS <br /> e4) Ks� pC• • AA.(, ■,r-A pv,t'c_ ►i'vy-- , m e-� <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: P P y <br /> ❑NUM ER 0708— a53-5555-9 G-D Q, SLI frontage drawn to scale. <br /> TOWNSHIP: SECTION: �� (� <br /> rn',d.6l Ve2A-o'n g 5 1/4: S to IRA:: N � Ig 6riveway permits 1•l A <br /> ADDRESS: ��,,,,.�,// (state, county, town) <br /> �O DC S- L\botd 1a, M.c,a\,ter, 'd i 5 7t.q anitary permits )..)� <br /> CSM: J..CdT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: - <br /> w a\ S C\ Q 1� G �q ,(}� Zoning District <br /> . ❑This project is a new building or structure. t- � <br /> P_ermittedlJse? <br /> ❑This project is an addition/alteration to an existing building or structure. �- <br /> SANITARY SERVICE: PERMIT NUMBER: r1 t[Ural Ad. '--: <br /> FIEWER [)EPTIC (new/z Istin• <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) / <br /> q O / IUWetfand/Flood p lain/ <br /> Shoreiand (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: Jo <br /> �d ErosionControl permit ` <br /> 7 5 4, TOTAL SQUARE FOOTAGE: 4, (Slopes disturbance <br /> 2ND FLOOR: 3RD FLOOR: <br /> 7 filling/aCC@SS) is <br /> 7 Uevlew Location Survey Pc <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies [ lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Peso ['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? EIfes ❑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 Elo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes []No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -0 --0 <br /> 545-112(4/08) <br />