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!II:=1:121121::::: <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> VyIAA •-%ttan►"e taAlea-(7a, ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 232-( Gtel c Q-•b, Co{k-cur(,yvue w' S 2,5 2 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> I (et-Z19-514 I 1 • laAaWa't ' tic.,.Co si ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> '\ r <br /> ❑Site Plan including location -•".AGENT ADDRESS CO TRAa •- .DRESS of well/septic <br /> (City,State,Zip) <br /> I Ci S tel( Z i p) ❑Setbacks a��( <br /> PHONE PHO E El Site Plan approval from/ 491) <br /> applicable township. 't` co• <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> .9oC <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER b Tit•,z-vs 300 ?,- I A (+ <br /> TOWNSHIP: SECTION: <br /> 6°ft-tter Gt-ov a ZZ .1/4: A/(.,) 1//. NW ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> V?Z( (Aploo - Vl. <br /> CSM: LOT SUBDIVISION BLOCKJLOT <br /> ❑Sanitary permits <br /> I Z. (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> P�dd'.tti� de4. --_____91143 CeoS ctef..l&. Lt d'tW1•QVyC,1 W7. Li Zoning District <br /> ❑This project is a new building or structure. ❑ Permitted Use? <br /> El This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: // U Rural Address <br /> EWER PEPTIC ` (new/existing) <br /> HEIGHT IN FEET `l NUMBER OF STORIES: (Not including basement) <br /> Dike. L_l Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ;i� <br /> BASEMENT 1ST FLOOR: �J ErosionControl permit <br /> ,--- + TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) <br /> 3 2L, Li Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ —10. and available options. <br /> (Please round to nearest dollar) 10,D d O <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ONo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes 0' o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Ries ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# I b21'/ ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Ekes Jlo ❑Don't know <br /> 7. Is this to correct a violation? ['Yes 'lo <br /> Q APPLICATION MUST BE SIGNED <br /> 545-112(4/08) r <br /> l�' 6 (Continue on Back) <br /> • Z <br /> 3 <br />