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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..QJA Sa y- LLC ning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Cv 53.06 p D S. Rc , CSCSfl, WT. 53719 Variance( #fiction; CSM ) <br /> HOA�GHO E ��51�C' L PHONE E-MAIL ADDRESS <br /> g'0% 7V E Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONT CTOR NAME <br /> '1 U1/4-.)k(..,Li V )/`'l -3„Q1C j ?rPSC2, �1,, n I , ite Plan including location <br /> AGENT ADDRESS i a CONTRACTOR ADDRESS ''1`�JJ of well/septic )j A- <br /> O 55 i2C-- rAa' `+ � el-So -1-- `j' <br /> (City,State,Zip) _ (City,Stat ,Zip) Q Setbacks <br /> f.EC—;or' c}Q1 6- .-5-=5-7 S (5 ., 0Sh W\ <br /> PHONE 1 PHONE 4 ite Plan approval from f <br /> i�0,S_ r3o\- - o}2� �9(J- oq- v0c C� applicable township. Y <br /> E-MAIL ADDRESS E-MAIL ADDRESS 1 - <br /> Pg1 K1�, c Ole AA.('o /rA •ki1t - Pr„tn^�I� 1, 14 e'� 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 /> ❑NUMBER 0-70S- a53-(6555 PARCEL -9 G- Q. SLI a frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> l� aal Ve-- jn Q5 1/4. s W 1�4y4: N k,(� 0 Driveway permits OA <br /> ADDRESS: (state,county,town) <br /> (0%06) S- b00 {Z 01, M a6\S r off. rj37l.R anitary permits dc CSM: T SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DE CRIPTION: /' <br /> `C1 n S n ' 0-4 \GI U (Min* L'� Zoning District <br /> . ❑This project is a new buildiTilg or structure. 2 Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. r <br /> SANITARY SERVICE: PERMIT NUMBER: >=J t'CUral Ad• "� <br /> F1EWER r)EPTIC (new/: 'stin• <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) , 0 <br /> I C / q r 1 a�Hand/Floodplain/ J� <br /> `11 Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) U EroslonCOntrol permit <br /> BASEMENT: 1ST FLOOR: I j TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 3 filling/access) <br /> 2ND FLOOR: 3RD FLOOR: II �, <br /> 3 I d..!'Review Location Survey 0 +T <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ and available options. <br /> (Please round to nearest dollar) $ 5 00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes Elo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yeslo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Elves ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [r'es ❑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) Ekes j�ii ❑Don't know <br /> 7. Is this to correct a violation? Elves [ o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -♦ —► <br /> 545-112(4/08) <br />