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ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN'• ME <br /> i6 gjiD/N (1 [l Zoning Status;CUP; <br /> OWNER ADDRESS(Number,Street,City,State,Zip) J '.� Deed Restriction;CSM <br /> H6 SVoYt, &OME PHONE c LLP" HONE 4,E A( /O,ess� 3,S7� Variance(# 15 301 ) <br /> Q !- 33-7L78,Y!, , 1 i 41 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR IN'F'ORMATION and includes dimensions <br /> AGENT NAME CO •'CTOR NAME <br /> Airy 0/7/,45 n..y (s m Site Plan including location <br /> AGENT ADDRESS 0 CTO34DDR€€SS of well/septic <br /> , D, /9x 1, 3 O <br /> (City,State,Zip) (cstaye,Zip) ��� � ®Setbacks <br /> 14. 1 �3 8 y ❑ <br /> PHONE PHONE Site Plan approval from <br /> oe- 3_1z-76 applicable township. <br /> E•MAIL ADDRESS E- AILADD' SS rn <br /> 4 4r, •. — v. A ,Z'p rJ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpJ/accessdane.co.dane.wl.usl) ®Elevation of property <br /> PARENT PARCEL NUMBER. C RENT ZONING: ACREAGE. <br /> PARCEL moi_ L.� t-'�y frontage drawn to scale. <br /> NUMBER lOStt 31'3-�3?LQ'U �� 1• J✓� JJ .yI�C7 <br /> TOWNSHIP: SE TION: / MI <br /> 11// ®Driveway permits <br /> IAF�1 '/4: _ '/a:sec. 3 (state,county,town) <br /> ADDRESS: O Dac j <br /> {� S ®Sanitary permits <br /> CSM LOT SUBDIVISION BLOCK/LOT (public,private) <br /> 30\ <br /> PROPOSED PROJECT INFORMATION _,,'STAFF REVIEW <br /> PROJECT DESCRIPTION: C1 <br /> S i ht 61 PAN..\ KE IDE,-4 GL. ❑Zoning District <br /> . 121This project is a new building or structure. 1 -❑:Permttfed Use?' <br /> This project is an addition/alteration to an existing building or structure. '< <br /> SANITARY SERVICE: PERMIT NUMBER- yl'^ I U Rural Address <br /> EWER EPTIC ZC7z 1 — VV t Lp Li? (new/existing) <br /> HEIGHT IN FEET: i/ YY)) NUMSER OF STORIES: (Not including basement) ❑Wetland/Floodplain/ <br /> >?horeland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: a ,: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT. 1ST FLOOR: 1� r 14314 troTPermlt <br /> 1 33 4 TOTALS DARE FOOTAGE: + `(S Dp ac?Ur�ance, <br /> g �. � 38 f ling/access} - <br /> 2ND FLOOR: 3RD FLOOR: q/ ; <br /> 6" ❑'Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: d and available options. <br /> (Please round to nearest dollar) D U�t�QO <br /> 1.The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes Rio :Don't know <br /> 2. Is there a wetland or floodplain on or near the property? :Yes ►. i o :Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Ives • o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes "lo <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) :Yes 'lo :Don't know <br /> 7. Is this to correct a violation? :Yes alo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -, <br /> REV(011191 <br />