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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C STOMER TO PROVIDE <br /> OWN, NAME I� <br /> 'sl�t D�� FuNre S ,L LC.- J Z ning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) _ <br /> '1.(0 7c?_ Gtti 24 la / (� 9 aft- ..3J 3 eed Restriction, CSM <br /> e� r ariance # ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS /� <br /> X08 y�8- 32g 3 �. h er T�.,rrr�r: t 7tePlandrawntoscale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ?-irc�s1/k'f''' I 5 b- ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> /.yG6 c- PA ►Y0 <br /> (City,State,Zip) (City,State,Zi Setbacks <br /> Jtz�, ��e 1cQ u S3s� I <br /> ❑ <br /> PHONE PHONE Site Plana val from <br /> 6 0 g - 3 .? -02 2- Lf lic township. <br /> E-MAILADDRESS MAILADDRESS n <br /> �eS kssdane.co.dane.wLus/) <br /> 1ca✓S (c(r��c.Y. C t,"` F oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREA 1 � y p p y❑PRCEL �� / ' p �Q�oo- i ��LL frontage drawn t ca e. <br /> NUMBER J W <br /> TOWNSHIP: SECTIO �, 1 <br /> CC Q Gt3 _ '/<: I�J '/<'/<: ❑Drivew ermits <br /> ADDRESS: ''°°^^vv11 (Stat , county n) <br /> CSM: LOT Cs-t- S BDIVISIONY . 0CWLOT ❑Sanita permits <br /> (•ub• ,private) <br /> PROPOSED PROJECT INFORMATION <br /> REVIEW <br /> DESCRIPTION: k a 3 ar°F <br /> ftel G-Ar- ij ei--f1ra-e—K S , ..1-....), e-. C / ® �snin District <br /> . ❑This project is a new building or structure. wit ,, <br /> his project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> EWER E)EPTIC � <br /> HEIGHT IN FEET. NUMBER OF STORIES: (Not including basement) <br /> 9 % �Z- Wetland/F.•.•p ln/ <br /> AREA TO NEAREST SQUARE FOOT: Shore) • (attaOment}'; <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: Cl. ErosionCon • • <br /> /o�� + TOTAL SQUARE FOOTAGE: 4, (slopes$ , <br /> 2ND FLOOR: 3RD FLOOR: / lllg/ } �� <br /> /6),-:° M D Review Lc cation. rve \C <br /> ESTIMATED CONSTRUCTION COST: andav S <br /> (Please round to nearest dollar) ", 3 _ -�� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Oyes .iNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 10`i'es ❑No EDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? laes ❑Plo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yeso <br /> 5. Is this project associated with a rezone/CUP/variance(petiti ❑ N <br /> on/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Elves o ['Don't know <br /> 7. Is this to correct a violation? ❑Yes Io <br /> APPLICAUT BE SIG <br /> (Continue on TION Back)M S ♦ -+NED <br /> 545-112(4/08) <br />