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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 /> If-e dtMGN Wing Status; CUP; <br /> OWNER ADDR SS (Nu r,Street,City,Sate,Zip) <br /> \ /407 7 S-67 ` U w t 1 Deed a(#fiction;CSM <br /> \./ HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Variance(# ) <br /> ,.i; "s % -° a Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> /7og'{Dh ,go'/d rl'y5 a Plan including location <br /> / NT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) etbackS S 13 <br /> /1 <br /> d �Jwi �C <br /> PHONE PHONE ! � El Site •la a► royal from <br /> long"9./5 0?399' appli - . - .wnship. /,'tied <br /> E-MAIL ADDRESS E-MAIL ADDRESS tin 1 <br /> Li <br /> 7 • oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) -o.i.,1 <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: vation of property <br /> El PARCEL NUMBER 0�/o1/5-a9-053-b' _7 �// o? 'o�Ljl j S rontage drawn to scale. y, <br /> TOWNSHIP: SECTION: <br /> •der°ti, 0S '/4: l c '/4'/4:,�GV riveway permits 'I°� <br /> ADDRESS: (state, nty,town) <br /> /g,p7 "mow 1 <br /> CSM: LOT SUBDIVISION BLOC OT q� S lic,private) <br /> /� <br /> public,private) / \/ <br /> SO ' <br /> PROPOSED PROJECT INFORMATION AFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ."4 ic-6 se /941/e �vi/�rz s)d- 4,t4,, I oning District <br /> . This project is a new building or'sfructure. itted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: — ❑ Rural Addr- <br /> EWER rEPTIC (n- - stin <br /> HEIGHT IN FEE NUMBER OF STORIES: (Not including basement) <br /> 64_11)1etlend/Floodplain/ <br /> l Shoreland (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: ❑ ErosionCOn I permit <br /> 3 0 L 1 j TOTAL SQUARE FOOTAGE: 4, (slopes,di rbance, J\J <br /> 2ND FLOOR: 3RD FLOOR: I [� fllling/8 ) V <br /> 3o /S�'Ft ❑ Revie L on Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ c� and alai options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ $ F3-000 <br /> 1j,/ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes lc[�t- to ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes o ['Don't know <br /> E] <br /> 3. Have you talked with the township about your project and are they in agreement? Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes EINo <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) QYes ElNo QDon't know <br /> 7. Is this to correct a violation? QYes QNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -+ <br /> 5455-112(4/08) <br />