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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> IOWNER NAMEIw�/'n/ I <br /> tegi ESS'dNumber Street �' State T y AQV'OR S ❑ Zoning District <br /> . TFC//14 //At ///ge/m lac 0.Ni rt Ond f'1,) W t ❑ Permitted Use? <br /> PHONE E-MAIL ADDRESS / <br /> // i -33.5-- S'd c.S ❑ Zoning Status;CUP; <br /> AGENT INFORMATION ' CONTRACTOR INFORMATION Deed Restriction;CSM <br /> AGENT NAME CONTRACTOR NAME <br /> variance(# � ?�� ) <br /> J 2 in r• � k b f Mat Aka �� b�1���r <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> ❑ Site Plan drawn to scale <br /> 1140, SO 10 S i 1(2 1&.c 4 4LCO Gies t SfKGPv S'1' • and includes dimensions <br /> (Cityy State,Zip) [,� (C' ,State,Z.ip) <br /> PF10NE1 (e � , " 1 At IC vk/ ill/ --c--y 7/' ❑ Site Plan induding location <br /> foi',0 `rJ `l- f q 0 d 4,)O - if y-91/00 of well/septic <br /> E-MAIL ADDR '^ �] E-MAIL ADDRESS ,y ��,}� ❑ Setbacks <br /> J ! 6 lLi' , LAY . I/ i„ / 1I , ,l .di HA <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Site Plan approval from <br /> PARENT <br /> ❑ PARCEL PARCEL NUMBER: ZONING: ACREAGE: applicable township. <br /> NUMBER 0/0-05-09 "I)I-6,13,i D f V\ W t a, p0` <br /> TOWNSHIP: SECTION:N:: ,t� <br /> _ Y�10 i vos e A)W 1/4: N a %%41/4: /a ❑ Rural Address <br /> ADDRESS: (new/existing) <br /> Stitt i4 i/e 4elP WaV ❑ Floor plans to scale <br /> CSM: on SUBDIVISION BLOCK/LOT <br /> ❑ Elevation of property <br /> PROPOSED PROJECT INFORMATION frontage drawn to scale. <br /> PROJECT DESCRIPTION: <br /> ❑ Driveway permits <br /> - 7,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: Li (public, permits <br /> (public,private) <br /> ❑SEWER IA SEPTIC `57 7f Y.C.-- <br /> HEIGHT IN FEET: / / •( NUMBER OF STORIES: (Not including basement) ❑ Wetiand/Floodplain/ <br /> 31/ '7 4v path_ 1 /..L Shoreland (attachment) <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 /> of /{/ 1 il ,V,/' 11. 1 y 3 j TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: { L ( 3RD FLOOR: ! c0 '�y/ <br /> S b / ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ - - ♦ ♦ ♦ AG/� and available options. <br /> (Please round to nearest dollar) /7 v 73 <br /> r <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes gi No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes ig No ❑Don't know <br /> 3. Have you talked with the township about your project? [I Yes ❑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 al No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes RI No <br /> Z' I/ i APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -i <br /> 545-112(1109) <br /> 4'�6f X 0.07 <br /> 917. o <br /> f-C? _ J <br /> ti bb' - o0 <br />