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ZONING PERMIT APPLICATION wuvw.count ofdane.co��G�. !1=11:32172227 <br /> ., ) <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 3—ok..n. 0 T,_ 0 Zoning Status; CUP; <br /> OWNER ADDRESS (Num er,Street,City,State,Zip) ^ Deed Restriction; CSM <br /> 1 rrO/J CT �� b C`_' }'vy11 --1� S,'-.3.,S ��S Variance(# ) <br /> HOME PHONE CELL PHONE IE-MAILADDRESS <br /> sit)`( �(o I ! ti - _ . . , VSite Plan drawn to scale , <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR ME 1N <br /> Site Plan including location <br /> AGENT-3c -i t ftk-fry ciecii-ONTRApro pbxDRS ' `i of well/septic <br /> (City,State,Zip) (City,State i ) 17jSetbacks <br /> PHONE PHON.1 ,Site Plan approval from <br /> 6'6.)8' we,/ CqD - --Ci -capplicable township. <br /> E-MAIL ADDRESS i E-MAILADDRESS '�-c� <br /> t,p r y } (- a •� /��Floor plans to scale <br /> ' ` i i . . I -AO l iCe.C, . R. + �ui �S 4l sir V ` <br /> PROPERTY/LOCATION INFORMATION (httpalaccessdan'..co.dlane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONIN , ACREAGE: <br /> PARCEL <br /> NUMBER J 0 - -oa_g`to_ u R M }� _S frontage drawn to scale. <br /> TOWNSHIP: SEC ION: ,�I i ,_ <br /> 0r� '/a: (V '/a: Ai' <br /> 1= �riveway permits <br /> ADORES 7 (state,county,town) <br /> 1 I r, `..'' n '1`.• - :/ )-(4'; .V1 2 Sanitary permits <br /> CSM: LOT SUBDIVISION BLfCK/LOT (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT. 1DESCRIPTIO : // ^- <br /> I`' 1,c,. w(k�0 r� \N.) ( \'11 % 2{ vim` 0 ZAning District <br /> oThis project is a new building or structure. *.1 -_ e -S Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ R mal Address N\ <br /> EWER 'TEPTIC '� - ?(D', `` iAi� ( w/existing) <br /> HEIGHT IN FEET: I NUMBER OF STORIES: (Not including basement) <br /> ") aWetland/Floodplain/ <br /> � ` Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: , <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: f J 1ST FLOOR: ': / ErosionControl permit L <br /> tt (Q TOTAL SQUARE FOOTAGE: (slopes,disturbance, <br /> 1,/ 1 (� `- t46 ` I �� 1 1 filling/access) <br /> 2ND OOR: 3RD FLOOR: a a/ g` �}' <br /> j v Review Location Survey IC <br /> ESTIMATED CONSTRUCTION COST: -•► _ . ♦ ♦ ,, �l 1� and available options. V <br /> (Please round to nearest dollar) p lr �l �i <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes \o laon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes QNo9.Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes Elio <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? EYes gNp <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) EYes QNo ]Don't know <br /> 7. Is this to correct a violation? EYes E*o <br /> 6k <br /> O <br /> `� APPLICATION MUST BE SIGNED <br /> (Continue on Back) -c -÷ <br /> REV(01/19) • 1 <br />