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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUS OMER TO PROVIDE <br /> /l <br /> OWNER NAME iy/'(t` 4 Co <br /> y Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM 411,1(s?D�.p .-Q IA)(9 0 { • f Deb' 6 35 7� Variance(# ) <br /> ..is HOME PH NE CELL PH NE E-MAIL DRESS <br /> -%.: i S ' 1'& e. c e 711 - 'm ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ctic d Cc)( a Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) tbacks <br /> PHONE PHONE 0 Site ��ly�pproval from <br /> appf a township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLus/) El ion Of property <br /> PARENT PARCEL NUMBER: CURRENT ZONI ACREAGE p p y <br /> El PARCEL NUMBER QUj /b5b1-17 f -g9y6"1 a�-I �I- p 4 rontage d awn to scale. <br /> TOWNSHIP: SECTION: 1 C/]3 , , D • e permi <br /> f�/� cy �4: C43 �4 n: <br /> ADDRESS: v ' ) // (st ,C Q,tow. - --)-i ..../ <br /> ' <br /> <O. 0 a-b �a .0 r 1 LL ' . rmit <br /> CSM: ' I LI LOT SUBDIVISION BLOCK/LOT (! • IC, : ivate)/ I/ 0 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: C_,....k n 5. <br /> C <br /> VA 11,1/4 ` Z nin istrict <br /> This project is a new building or structure. rmitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Rura <br /> EWER rAEPTIC (ne (existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 3*--' 1<>: ,� 1 We IF plain/ <br /> Sh (attachment) <br /> AREA TO NEAREST SQUARE FOOT: _ <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) Erosio Con permit <br /> BASEMENT 1ST FLOOR: <br /> 10& + TOTAL SQUARE FOOTAGE: j (slopes sturbance, <br /> 2ND FLOOR: 3RD FLOOR: fiI aCC S) <br /> IC)CD Revie Loca . Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ �,t1 "0 0. °" and ava a options. <br /> (Please round to nearest dollar) i / <br /> 4 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes No EDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Oyes no ElDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes IE:lNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Lives glo <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) Oyes 1 o QDon't know <br /> 7. Is this to correct a violation? Dyes 0 o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) - -÷ -i <br />