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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C TOMER TO PROVIDE <br /> OWNER NA Z <br /> +e-tl-e. +rl 1 6 \ V Z ping Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) t eed Restriction; CSM <br /> l o Sh�rno, - C�ct�Y S �3 ariance(# _) <br /> HOME PHONE CELL PHONE )1 E-MAI DDRESS <br /> _•54 43- 3 / 1.05C -7.74' 5'�ci (i , 43 v t\ % th Si a Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION a d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> O W41 t( I r. s c. le Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> (City,State,Zip) (City State,Zi ) Setbacks <br /> r tralV1. (U5351-1 <br /> PHONE PHONE ❑Si a Pla proval from <br /> L0 Z-1 411 3Z00 a li le township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> oor . :ns to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CU RRENT A NING: ACREAGE: Ele ation of property <br /> y <br /> 0 PARCEL `NUMBER 0 51+f OIP 07-°(1' iC 0 <br /> Q S lib fr• a drawn to scale. <br /> TOWNS SECTION ` <br /> F. ` Ltcountyown) <br /> ��a. Imo'/a'/a. <br /> 31 1 ,*, 1--Ikvki, p ��. 4:3'ae,\„wl S 7 Sani .ry permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION S AFF REVIEW <br /> PROJECT DESCRIPTION: IIII <br /> S \f- u_ , ac- ■ Zo,ing District <br /> . IN This project is a new building or structure. <br /> ❑ Permii#-, • - <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural dre <br /> [ EWER FT EPTIC , 3 - 2,0/ 2 000 3• (new/:-. isti • <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> L/ <br /> 0 It ' ❑ Wetlan• •••p1a. <br /> in/ <br /> Sh• <br /> and (attachm-nt) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT 1 ST FLOOR: /� ❑ ErosionCo• .of permit <br /> 95-3 L !�j .q- j32 1` + TOTAL SQUARE FOOTAGE: 4, (slope disturbance, r‘ <br /> 2ND FLOOR: 3RD FLOOR: ,F7 2/ flr�l ! access) <br /> 3 7 I °� (P . ❑ -eview Location Surve <br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ♦ ♦ ♦ ♦ and available <br /> round to nearest dollar) $ I ? Cr . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes No Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes o Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? NYes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes 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) Elves No ❑Don't know <br /> _46( <br /> 7. Is this to correct a violation? Yes No <br /> f S 0 APPLICATION MUST BE SIGNED <br /> !� (Continue on Back) -+ -* <br /> 545-112(4/08) <br /> ■ <br />