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af _ter ,-- <br /> —� (.f . b,6 . 65'.0 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> /1erP�v. ced r�4get 1P toi g ,1 ❑Zonin Sta ; CUP; <br /> OWNER ADDRES (Number,Street City,State,Zip) i <br /> '714 /(y�ff4sen st ,mn <br /> C 1!vi e, W' 535,23 Deed a riction; CSM <br /> HOME P ONE . �CIELL PHONE E-MAIL ADtD�RESS; f Varian (# ) <br /> /; 5L YAK (n a hone& ahvt cm ❑Site PI drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and in des dimensions <br /> AGENT NAME CONTRACTOR NAME r R j ck rim/rim/vier r Jorth eYf ri is <br /> S ❑Site Plan intxt Ing location <br /> AGENT ADDRESS CO TRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (Ci State,Zip) ��I ❑Setb cs <br /> PHONE P ON ) ❑Site PJJvnI-�4 •val from <br /> 7Z5 i2 °Al g applit�t31� o nship. <br /> E-MAIL ADDRESS My4ILADDRESS p <br /> r,ek oh04erh tit 1 t- 'I ❑Floor pl to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.darie.wi.usn <br /> PARENT • PARCEL NUMBER: CURRENT ZONN G:l ACREAGE: <br /> ❑Elevatio f operty <br /> 1:NUM ER al 1t'.. C.% "e4 9%0 .d u 'd�V�-hail <br /> 24,37 frontage n to scale. <br /> TOWNSHIP C ION: <br /> Dee�f j e , 1/4:1E____ %.,,,: ❑Driveway permits /JO a,CC <br /> ADDRESS: t t , county,town). <br /> .("-) 0 Z'f-4/fe \ <br /> CSM: LOT SU EIDISII ON Aitt LOCK/LOT ❑S- ,I - e(f t ellitai4...., <br /> // / I <br /> �. j (•/, . :.)x 11 iva t <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION; i <br /> . __j,_ '1•4-1- <br /> _ le � t)d_ y'1 t o_ ❑ Zonin rid <br /> . his project is a new building or structure. <br /> ,_....1 V <br /> ❑ Perrri I Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ RU al Address <br /> FIEWER PEPTIC ( /existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ,R5 fed- (fie ❑ Wetla d/ •.slain/ <br /> AREA TO NEAREST SQUARE FOOT: Shorr l F;c ment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ ErosionControl permit <br /> PAgFMtiv7. 1STF.0^R: �_ i <br /> /- h -,,...„(4,4,, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, wait-4 <br /> a ���� filling/access) (gyp! <br /> 2ND FLOOR: 3RD FLOOR: <br /> r,— rs/1 a E� �/�. <br /> . <br /> lt. '- J�7 t <br /> _._ 0 ❑ Revie urvey <br /> ESTIMATED CONSTRUCTION COST: ♦ -i ♦ ♦ ♦ d` ��� and a i e ptions. <br /> (Please round to nearest dollar) w rod <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [ Vo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes y❑flo ['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? ❑Yes Ilo <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 .26o ['Don't know <br /> 7. Is this to correct a violation? ❑Yes Flo w <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -+ —► <br /> 545-112(4/08) <br />