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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ��yyf�� 1��:j i✓ {14! Z14�1 �Z�oning Status; CUP: <br /> owr11 RA,DRESS` um er, t fit,Cir/v.Stat Zip) Deed Restricts n; CSM <br /> 3c 644 AfttL/,r ifieeo%'1 kJ/ ,5".17/x- Variance(# ) <br /> HOME PHONE ELL PHONE E-MAIL ADDRESS <br /> j,1--AO — '" a g ' i 4 v tP '1„.d V. , Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME Site Plan includinglocation <br /> kl�ALA2 a J E44Pe .1 f�i c iiti I y Ca-41T LLQ <br /> AGENT ADDRESS n n CONTRACTOR ADDRESS of well/septic <br /> 7!fugla s'/717A60614- l�/J x'egost <br /> (City,State.Zip) (City,State,Zip) Setbacks <br /> Q-ZJ$ Pim/yL f kir 35 <br /> PHONE PHONE C Site Plan approval from <br /> 6'05,_ ,7L - Co Li a applicable township. <br /> E-MAIL AQDRESS E-MAILADDRESS <br /> 6614 <br /> lOor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) �evation of property <br /> PARENT I PARCEL NUMBER: CURRENT ZONING: ACREAGE: 70 <br /> PARCEL I,, y J�,7 RR-2 / frontage drawn to scale. <br /> NUMBER ��0�",D/y`&•)0-D K!T I 2, Y' i-i <br /> TOWNSHIP: SECTION: <br /> Ukk4 t I 7 %: OE, .[) 1A: Of 4/4/ Driveway permits <br /> (state.county,town) <br /> ADDRESS: p <br /> 274. /RiiI i2/E e-1 E Alm of I k ,,4 Sanitary permits <br /> CSM: i LOT SUBDIVISION I BLOCK/LOT 4 BR <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTIOk_ <br /> SR W/ DECK 4 BEDROOMS ❑ Zoning District <br /> • arThis 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: U Rural Address NEW <br /> EWER EPTIC /3 ,. 2-<)21 00/OP (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) NO <br /> 2 ❑ Wetland/Floodplain/ <br /> �l /� Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) r----, ErosionControl permit <br /> BASEMENT: 1ST FLOOR: EC,' 021 <br /> 1/ �^ TOTAL SQUARE FOOTAGE: l (slopes,disturbance, <br /> 2&)'/ �' (�"( ' Z/5 �� j 7117 filling/access) -01::5 <br /> 2ND FLOOR: j 3RD FLOOR. -7 <br /> Dn. �= (z°j" // 1 0.0 .f'4. - 'i ❑ Review Location Survey NO <br /> ESTIMATED CONSTRUCTION COST: _. -+ ♦ ♦ ♦ Q� `/77 and available options. <br /> (Please round to nearest dollar) �D <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes \loEDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Oyes no EDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes to <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Efres a.o <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) nYes \lo °Don't know <br /> 7. Is this to correct a violation? Eyes govo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -► -► <br /> REV 401'19] <br />