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ZONING PERMIT APPLICATION www.countyofdane.com EICIMIZICECC=11! <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Ottrl I.<l r e r► k4 Huzbsc,I1 <br /> OWNER ADDRESS (Number,Street,City,State,Zip) -- ------ O Zoning Status; CUP; <br /> 5'S's r btJinc� titiA� �t!j S Deed Restriction; CSM <br /> HOME PHONE CELL PHONE <br /> v rG�on <br /> ADDRESS Variance(# <br /> C -112.- 713r k&I`' b 5 C-h 41 `'f`/` I ' - ' ',--10 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> R'i4 1 ifs J a/ s3 elf Pt IS,r.1 pa3 [] Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> Pc 6oJfL Pe 13 c.)( VC, <br /> (City,State,Zip) (City,State,Zip) <br /> I le of d ie WI- 9 3 cot q I�:.'n t .I/b' VI. j 1'1�-I q — nSetbacks <br /> PHONE PHONE El Site Plan approval from <br /> ‘t F- '3`- o 9N 4.p -.2. -Z y'"— applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> rhmetlG11 QW ) ,CG 4 . (.QJ4 rncedcll! a ,4.i pc'ots , Gv+1'' Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: El Elevation of property <br /> ElPARCELSFR-1 frontage drawn to scale. <br /> NUMBER t332JOco - 164 13c1-7 1. I g <br /> TOWNSHIP: SECTION: <br /> ICI C t 0 r Z,(.4 C rt I L 1/4: IAC 1/4: S. El Driveway permits <br /> ADDRESS: (state,county,town) <br /> 5i-')--1,0,r4 r► tl y Rd 0( 9&.'•7 wt 5"s,c 71� El Sanitary permits <br /> CSM: LOTS I O BLOCK/LOT <br /> IM <br /> 9 � IIDGE (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 1711'q) T oyt Veld /p 1M y mt with gvfv Gel ti ?." t Zoning District <br /> . ®This project is a new building or structure. Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Rural Address EX <br /> EWER oEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) NO <br /> -ici Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> -- Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: �Er0510nCOntf01 permit NC <br /> 4, TOTAL SQUARE FOOTAGE: j, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: `— filling/access) <br /> -1L 0.0 <br /> 'Review Location Survey N <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ 9/ 3 ' (� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Wes ONo [Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 01'es ENo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Oyes YINo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Oyes KNo <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 EINo ElDon't know <br /> 7. Is this to correct a violation? [Yes [INo <br /> $122.00 <br /> r,.,..-r''_.— APPLICATION MUST BE SIGNED <br /> REV,o,,,91 - '-'"r (Continue on Back) -40 -0 <br />