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A - <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWNER NAME <br /> Ter(V .- 4-(Acirot 2 vOI'd ❑ Zoning District <br /> OWNERADDR�SS (Number,Street,City,State,Zip) <br /> 841 LI )l i rt5 fo v, L Ja y, YYI i dd le i-o n kJI S 35 L,a- ❑ Permitted Use? <br /> PHONE E-MAIL ADDRESS <br /> (,01-ao3-SYS-G <br /> ❑ Zoning Status;CUP; <br /> AGENT INFORMATION (CONTRACTOR INFORMATION Deed Restriction;CSM <br /> AGENT NAME CONTRACTOR NAME Variance(# ) <br /> lCt VAT ACC Cushman (onS4ru.cf-i <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> ❑ <br /> 9`110 E l m wood Ci r. W esE Site Plan drawn to scale <br /> (City slate,Zip) and includes dimensions <br /> (City,State,Zip) <br /> Crc plct;r`s iv i S 3S 2.V ❑ Site Plan including location <br /> PHONE PHONE of well/septic <br /> (00 8-79.1'- I <br /> E-MAIL ADDRESS E-MAIL ADDRESS ❑ Setbacks <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Site Plan approval from <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: <br /> ❑ <br /> NUMBER G 10 -0 SI-ol i Sa-'a 4-1 applicable township. <br /> TOWNSHIP: SECTION: <br /> SH k etA y o 0 5 IA: N E //: (\AV ❑ Rural Address <br /> ADDRESS: (new/existing) <br /> 8414 E II i►'y}on way, tVi t&(al le tnn WI S 3S too- <br /> 0 Floor plans to scale <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> SA Y1'DYv biz&C- ic-44t. <br /> ❑ Elevation of property <br /> PROPOSED PROJECT INFORMATION <br /> frontage drawn to scale. <br /> PROJECT DESCRIPTION: <br /> Za5 Mil//1a) a (CSS IaJ:ncioco w-(fLe <br /> ❑ Driveway permits <br /> • ❑This project is a new building or structure. (state,county,town) <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: El (public, permits <br /> CI SEWER ❑SEPTIC N/�+ N/q (public,private) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not inducting basement) ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) 1 <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT 1ST FLOOR: <br /> N I A PIA ,` TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> '/'x y' filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> NIA Nlq i40 <br /> ESTIMATED CONSTRUCTION COST: ❑ Review Location Survey <br /> (Please round to nearest dollar) ♦ -to- -4. - . .- -4 $ _),060.00 and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes GiiNo ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes C'No ❑Don't know <br /> 3. Have you talked with the township about your project? C4(es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes Et/No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes Cl to <br /> /, 0 APPLICATION MUST BE SIGNED <br /> 545-112(1/08) �v c� (Continue on Back) .+ ♦ -► <br />