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reSeri e et Lt-15 <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> !=:=2213! <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME b� I -- V <br /> JDor1UICi +I CtTtf'L'4 e'r Zoning Status; CUP; <br /> oAv(4 A DRESS (Number,Street.City,State,Zip) <br /> tI� ,-S Deed Restrictio CSM <br /> l4vj tct (1'�Gt2.0lllY atme.. , WI 1J 35 400 variance(# D'5?0 ) <br /> 10645 PHONE �,LLL NE E-MAIL _ Q <br /> "�0q "' '/S 75-25v Site Plan drawn to scale /le <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions pn esrrl <br /> AGENT NAME ` C TT ACTOR NAME l <br /> Sohn lima h Yvl ) be , �/hQ� / h�&c �nia `I7C, _ Site Plan including location <br /> AGENT ADDRESS / CONTRACTOR ADDRESS / of well/septic v <br /> 1000 6(15, Hioy 13. so MI 3470 N._Qoli►hymattdab_-Dr- _ �( aced? <br /> (City,State,Zip) �+ �� (�q (Cit ,State,Zip) ^!S Setbacks 014 C <br /> htA,.56-Rci , WI S9�! / F0"ic Jo Lac. WI 5 37 ite Plan approval from <br /> P ONE '�"" I" <br /> �i1 ') Sl2"tp33Ycel/ (715)5-la-03ej applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS A 9 hep�� <br /> X Floor plans to scale `"' ^^�`� "f""'"^^ <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) f MA- fgi (,e <br /> PARENT PAR L NUUMBER CURRENT ACREAGE: - o/ If Elevation of property <br /> j PARCEL Qr / / ��99 AE CV _ b frontage drawn to scale. t/ <br /> NUMBER (�J ! �/V T1L <br /> TOWNSHIP: SECT ION.att 1 R7E — . arX/S�i%Xj Qi1SErlhiror+/" <br /> 1UWY1 eirq I__ <, + 1/a;_'Jut! '/4'/a: _ Driveway permits/V/4 1/• <br /> ADDR ��j�] v (state, county,town) <br /> 1 HW`j 19 ma2oeh 4 iSrl a• i W 1 S 3 S(O° Xib Sanitary permits <br /> csM. �{ L (public,SUBDIVISION IBLOCK/LOT <br /> r . IV((�J ublic, rivate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: wj tax/2 DLG <br /> Ovi I d/Plr.,u, a 19459,Ahothi on busetittrd-Fvve I/01 Gn(l2L '.rZy4lpuu/ _ 'Li Zoning District r� <br /> y 4t. <br /> . N This project is a new building or structure. <br /> [L] Permitted Use? <br /> Li This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER V ural Address <br /> .J SEWER SEPTIC 5 I'i T (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES (Not including basement) <br /> J Wetland/Floodplain/ <br /> ��IC. `!�� — — - Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) r ll <br /> BASEMENT ST FLOOR J ErosionControl permit <br /> I96a 4 I + TOTAL SQUARE Fr+OOTAGE: 4 (slopes,disturbance, <br /> 5159 z��0��7`r —_-_— filling/access) <br /> 2ND FLOOR 3RD FLOOR: ����'sg J Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ _0. _0._0. ..... and available options. <br /> (Please round to nearest dollar) /��900 <br /> • <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 1 Yes No Li Don't know <br /> 2. Is there a wetland or floodplain on or near the property? .1 Yes XN o J Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? X Yes D No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? � J Yes XNo <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# Ci4 `f'3) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) e&es U No ❑Don't know <br /> 7. Is this to correct a violation? U Yes XNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► <br /> 54/t L taros <br /> � I� * vL 6 5/24 <br />