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Ls f s g-, 5-f-rccuvm 7-P4V-1-`4 7 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> ° NAME CUSTOMER TO PROVIDE <br /> A //q,--k i —TOT,-.1 se Lito,-x 1-ipuo-e el OWNERADDRESS (Number,Street,City,State,Zip) b' can ping estrU8;c;CSM WY 41 st)-1/ !� PI:D��O� Deed Restriction;CSM <br /> HOW 15-07 CELL PHONE l e s3 5- Variance(#` <br /> E-bWLADDRESS <br /> b a j 25<.? ©YSite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION <br /> A NAME roR and indudes dimensions <br /> AGWIIT Y1 JC il O-eio C C7,A L LeC �6'• <br /> �ADDRESS G “::Plan including location <br /> /1 1 DD ES �� CONTRACTOR ADDRESS of w ell/septic <br /> //(( �/ ( 34 /1,4ey.6-, ( So -e AS 11G•�--,-F i <br /> ( State,ZIP) (City,State,Zip) LTSetbac Setbacks <br /> 41,4( <br /> NE 10 t t L 3-? <br /> O g-o� �� l/ PHONE I:3 Site Plan approval from <br /> / applicable township. <br /> EMAIL ADDRESS E-MAIL ADDRESS <br /> 'P '. MA , �1)46��F fr1Q Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) <br /> ❑ <br /> PARENT PARCEL NUMBER: CURRENT NG: ACREAGE r� 0 Elevation of property <br /> TO b i/C��( d V- P �/5 frontage drawn to scale. <br /> (state,cou town) <br /> A o -9,A / r) 1- 0Qd A�° <br /> -7 <br /> S,U��,�',V,I ION) BLOCK/LOT <br /> permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECTT scRIP { /STAFF REVIEW <br /> ' "4 k /1.. G1-0`'� 0,11 e. �/ 6 G P lA-,✓> cR 1a"Zonin District <br /> 9 <br /> s project is a new building or structure. <br /> 0 This project is an addition/alteration to an existing building or structure. G�i'errrlAdd Use? <br /> SANITARY , , PERK N„�, 2 ' u(a/Address q <br /> HEIGHT IN FE �° � L (new/existing) " ' <br /> 21 NUMBER OF STORIES: (Not including base) .,� <br /> ii; W@#and/Floodpiain/ <br /> TO NEAREST SQUARE FOOT: S eland (attachment} <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ErosionControl permit eASEMENr t FL (SIO ,disturbance, 00066 I G U � r� 1, j TOTAL S DARE FOOTAGE j <br /> 2ND g . 0 ar FLOOR: 530 P„j, fitlin access) <br /> ESTIMATED CONSTRUCTION COST I evIew Location Survey <br /> (Please round to nearest dollar) ♦ -► -► -► -► -► 7�. SL� and available options. <br /> 1. The property is within 300 f e e t o f a s t r e a m or 1000 f e e t f r o m a pond or l a k e? S t i Yes lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No 411.5on't know <br /> 3. Have you talked with the township about your project and are they in agreement? EYes 0 No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes W.No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# <br /> � <br /> ) (I.- = blank if none) <br /> 6. Is a location survey required? (see reverse) es 0 No '6on't know <br /> 7. Is this to Correct a violation? ;I Yes 14-No <br /> APPLICATION MUST BE SIGNED <br /> 5'612 MB) <br /> (Continue o NBack} -� -n► <br />